Common Antiretroviral Therapy Drug (Tenofovir) Associated With Decline of Renal Function
10/26/2009
Commonly used tenofovir, a nucleootide reverse transcriptase inhibitor (NRTI) used in anti-retroviral therapy (ART) is associated with declines in renal function, according to researchers at the Kaiser Permanente Division of Research in Oakland, CA. The study appears in the current online version of The Journal of Acquired Immune Deficiency Syndrome.
The potential long-term toxic effects of tenofovir on renal function have not been widely studied in large clinical and managed care cohorts, according to the authors.
“This study, which looks at a population of patients in a large
integrated care delivery system, indicates that there is a statistically
significant effect of tenofovir on renal function in patients who have
never been on antiretroviral medications previously and are now
initiating antiretroviral therapy,” said Michael Horberg, director of
HIV/AIDS for Kaiser Permanente and lead researcher for this study. He
added that the researchers also found that tenofovir exposure was
associated with a great risk of developing proximal tubular dysfunction,
another potential harm to the kidneys.
“The potential long-term adverse affects on kidney function may limit
use of tenofovir for patients risk for renal complications. Also,
long-term monitoring of renal function and proximal tubular dysfunction
in patients taking tenofovir should be considered.”
Researchers performed a retrospective cohort analysis of HIV infected
patients in California, Maryland, Virginia and the District of Columbia.
All were Kaiser Permanente patients initiating a first ART regimen from
January 2002 through December 2005. While the researchers note that
this topic warrants additional longer-term studies, the study is
significant for its patient population size, persistence of the adverse
renal effects over time, and the ability to control for a variety of
co-founders potentially associated with renal dysfunction, such as
patient demographics, co-morbidities and other medications prescribed.
Additional authors on the study include Beth Tang, MA, with the Kaiser
Permanente Center for Research and evaluation; William Towner, MD, an
HIV Medicine specialist at Kaiser Permanente in Los Angeles, CA; Michael
Silverberg, PHD, with the Kaiser Permanente Division of Research; Susan
Bersoff-Matcha, MD, with the department of infectious diseases at
Kaiser Permanente in Rockville Maryland; Leo Hurley, MPH, with the
Kaiser Permanente Division of Research; Joseph Chang, PharmD, with
Kaiser Permanente in Los Angeles; Jackie Blank, MBA, with Kaiser
Permanente in Rockville Maryland; Charles Quesenberry, PhD, with the
Kaiser Permanente Division of Research; and Daniel Klein, MD, with the
department of infectious diseases at Kaiser Permanente in Hayward, CA.
Funding for this study was provided by Gilead Sciences, Inc.
About the Kaiser Permanente Division of Research (http://www.dor.kaiser.org/)
The Kaiser Permanente Division of Research conducts, publishes, and
disseminates epidemiologic and health services research to improve the
health and medical care of Kaiser Permanente members and the society at
large. It seeks to understand the determinants of illness and well-being
and to improve the quality and cost-effectiveness of health care.
Currently, DOR’s 400-plus staff is working on more than 250
epidemiological and health services research projects.
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