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The Renal Impact of Tenofovir Disoproxil Fumarate in the NA-ACCORD
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Reported by Jules Levin
CROI 2016 Feb 22-24 Boston
Ruibin Wang1, Gregory Lucas1, Michelle Estrella1, Michael Shlipak2, Marianne Harris3, Michael Horberg4, Mari Kitahata5, Angel Mayor6, Sonia Napravnik7, and Alison Abraham1for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA1Johns Hopkins University; 2University of California, San Francisco; 3British Columbia Centre for Excellence in HIV/AIDS; 4Mid-Atlantic Permanente Research Institute; 5University of Washington; 6Universidad Central del Caribe Retrovirus Research Center; 7University of North Carolina at Chapel Hill
Summary of results:
⋅At baseline, TDF initiators were older, and more likely to be male, on ART and virologicallysuppressed, to have higher eGFR, higher CD4+ cell count, current or recent ritonavir-boosted protease inhibitor and atazanaviruse, and hypertension. (Table 1)
⋅1-year eGFR trajectory: In patients with reduced kidney function (eGFR<90 mL/min) at baseline, TDF was associated with faster eGFR decline from 0 to 6 month, followed by a recovery of kidney function between 6 to 12 month post-ART. For those with baseline eGFR≥90 mL/min, 1-year eGFR change was not significantly different by treatment groups. (Figures 1-3)
⋅1-year eGFR change vs. long-term ESRD risk:There were 68 incident ESRD that occurred among those who stayed on TDF or NRTI-containing therapy for ≥1 year. In this group, rapid eGFRdecline (>25% loss in eGFR and to a level of <60 mL/min) during the first year of ART was associated with higher risk of ESRD in patients with baseline eGFR<90 mL/min. This risk was similar by therapy types. (Table 2)
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