Tenofovir-treated HIV associated with increased CKD rate for adults in Tanzania
Key takeaways:
- CKD incidence was more than twofold higher among adults in Tanzania taking tenofovir vs. adults without HIV.
- Those with HIV on tenofovir also had more rapid decline in kidney function.
“Managing CKD among people living with HIV in low-income countries has unique challenges owing to resource constraints and a lack of studies informing context-appropriate CKD screening and monitoring strategies,” Nicholas L.S. Roberts, MPH, a medical student at the Weill Cornell Medicine Center for Global Health in New York, wrote with colleagues. “In sub-Saharan Africa, including Tanzania, the first-line antiretroviral therapy regimen includes tenofovir disoproxil fumarate, which is more nephrotoxic than the alternative formulation, tenofovir alafenamide, which is preferred for patients with renal insufficiency and used more widely in high-income settings.”
The prospective parallel-group analysis conducted from 2016 to 2021 tracked 505 adults in Tanzania without HIV and 95 adults enrolled in public HIV clinics with newly diagnosed infection starting tenofovir disoproxil fumarate-based antiretroviral therapy. Mean age of participants was 35 years, and 67.5% of the cohort were women.
After gathering patient sociodemographic information, health behaviors and history of hypertension or diabetes, researchers focused on key primary outcomes: annual eGFR change; incident albuminuria; 3-year all-cause mortality and incident CKD, defined as a follow-up eGFR less than 60 mL/min/1.73 m2 with at least 25% reduction from baseline.
CKD incidence was more than twofold higher among adults with HIV, according to the findings, with 71 total cases compared with 30 in the control group. This ratio was equivalent to a CKD rate of 57.9 per 1,000 person-years for those with HIV (95% CI, 44.4-71.4) and 26.2 per 1,000 person-years for those without (95% CI, 16.8-35.5).
Further, adults with HIV had more rapid decline in kidney function vs. controls, with an annual eGFR change of –6.65 mL/min/1.73 m² vs. –2.61 mL/min/1.73 m², respectively.
Female sex and older age were positively associated with CKD incidence among participants, the researchers found. Albuminuria rates did not differ by HIV status, but adults with baseline albuminuria had higher risk of mortality (HR = 2.13; 95% CI, 1.08-4.21).
International CKD guidelines “among [people living with HIV] PLWH should recognize the limited diagnostic capacity and lack of treatment alternatives of HIV clinics in sub-Saharan Africa and tailor guidelines to these settings, given they are where the majority of PLWH globally seek care,” the researchers wrote. “Expanded [tenofovir disoproxil fumarate] availability, increased laboratory capacity, and integration of CKD preventative services into routine HIV care are urgently needed.”
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