Slight risk for PTD identified in girls receiving tenofovir

Female pediatric patients who were exposed to tenofovir for more than 1 year had an increased risk for proximal tubular dysfunction, according to a poster presentation at the XIX International AIDS Conference.

Perspective from Michael T. Brady, MD

Researchers from Emory University conducted a prospective cohort study to measure the risk for proximal tubular dysfunction (PTD) among children and adolescents with HIV receiving tenofovir (Viread, Gilead Sciences). The study included 110 patients receiving tenofovir and 68 children receiving a non-tenofovir regimen who were followed for 12 months. Most of the patients were black and the mean age of the patients was 15.7 years. At enrollment, 62% of the patients had undetectable viral loads and the mean CD4 count was 550 cells/mm³.

There were 15 cases of PTD in 13 patients. One of these patients had never received tenofovir, three received tenofovir for less than 1 year and 11 received tenofovir for 1 year or more. Gender and duration of tenofovir exposure were associated with PTD. Females who were exposed to tenofovir for more than 1 year had a slight increased risk for PTD (P=.0016).

Patients who received tenofovir for longer periods of time had lower levels of phosphorus and creatinine clearance. Measuring levels of beta-2 microglobulin did not serve as a marker for early detection of PTD.

For more information:

Camacho-Gonzalez A. #MOPE66. Presented at: XIX International AIDS Conference; July 22-27, 2012; Washington, D.C.

Perspective

Michael T. Brady, MD

Tenofovir has been a valuable addition to the antiretroviral armamentarium. Unfortunately, tenofovir has been associated with nephrotoxicity and bone loss in some recipients. This study evaluated 178 children and adolescents (110 on a tenofovir-containing regimen and 68 on a non-tenofovir-containing regimens) to assess the frequency and risk factors for proximal renal tubular dysfunction (PTD). There were 15 episodes of PTD (1 no tenofovir exposure; 3 with <1 year of tenofovir exposure; and 11 with >1 year of tenofovir exposure). Female sex and tenofovir exposure for >1 year were significant variables in the development of PTD. Longer exposure to tenofovir resulted in lower levels of phosphorus and creatinine clearance, and was predictive of early PTD. Beta-2-microglobulinuna was not a predictive marker for early detection of PTD. Tenofovir is still extremely valuable in the management of HIV infection in children in adolescents. However, serial phosphorus and creatinine clearance assessments may assist in detecting early PTD.

Michael T. Brady, MD

Chairman, AAP Committee on Infectious Diseases

Children’s Hospital Columbus

Disclosures: