Incomplete Reversibility of Tenofovir-Related Renal Toxicity in HIV-Infected Men

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Background:Significant nephrotoxicity develops in 1%-2% of HIV-infected adults receiving tenofovir (TDF). This nephrotoxicity is said to resolve rapidly, but this assessment is based on short follow-up, very few patients and use of serum creatinine, an insensitive measure of renal function.Methods:We determined the reversibility of TDF-related nephrotoxicity in 24 HIV-infected male outpatients who ceased TDF for renal impairment by retrospective assessment of estimated glomerular filtration rate (eGFR) using the Modified Diet in Renal Disease equation.Results:Median (interquartile range) eGFR pre-TDF was 74 (61-88) mL·min−1·1.73 m−2, fell to 51 (39-61) mL·min−1·1.73 m−2 at TDF cessation and increased to 58 (48-70) mL·min−1·1.73 m−2 a median 13 months after TDF cessation (most recent vs pre-TDF eGFR; P = 0.0008). Results were similar with the Cockcroft-Gault equation and after exclusion of patients who had shorter follow-up after TDF cessation. Only 10 (42%) patients reached their pre-TDF eGFR. Greater eGFR improvement was significantly associated with more rapid decline in eGFR on TDF therapy and in those who received TDF with a protease inhibitor, with a trend for shorter duration of TDF therapy.Discussion:In this population, TDF-related renal toxicity was not always fully reversible.

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