Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort 英文参考文献.docVIP

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Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort 英文参考文献.doc

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Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort 英文参考文献

Chuaetal.AIDSResearchandTherapy2012,9:19 /content/9/1/19 SHORT REPORT OpenAccess Renalsafetyoftenofovircontainingantiretroviral regimeninaSingaporecohort ArleneCChua1*,RyanMLlorin1,KelvinLai2,PhilippeCavailler3andHwaLinLaw2 Abstract Background:Tenofovirdisoproxilfumarate(TDF)isanucleotideanaloguewidelyrecommendedininternationalHIV treatmentguidelines.TheassociationofTDFandrenaldysfunctionhasremainedanareaofinterest. Findings:WeconductedaretrospectivereviewofallpatientsonTDFfromJuly2007toDecember2009inour institutionandevaluatedtheirrenalfunction.Absolutechangeofcreatinineclearance(CLCr)usingCockroft-Gault equationfrombaselinewascalculatedat6,12,18and24months.Overall,226patientswereincludedinthestudy. Ninetypercentweremale.Themedianagewas46yrsold(23–82),medianweightwas60kg(IQR53.75-68), medianCD4countwas127cells/mm3(IQR38–258)andmedianCLCr82.7mL/min(IQR71.4-101.7)oninitiationof TDF.ThemediandeclineofCLCrfrombaselinewas?3.9ml/min(IQR?12.3to7.6),and?3.6ml/min(IQR?12.4to 6.7)at12(n=102),24months(n=75)respectively.Eighteenof226patientshadadeclineinrenalfunctionto /=50ml/min.MajorityofwhichhadanimprovementofCLCronfollowup.Only80%ofpatientseverreceived monitoringofrenalfunction. Conclusion:WhilewenotedrenaltoxicitytoberareandtransientamongourcohortreceivingTDFaspartoftheir ARVregimen,theseresultsreflecttheshorttermrenaleffectsofTDFgiventhatARVtreatmentislifelong.Given thatlaboratorymonitoringmaybedifficulttoimplementinmanysituations,futureprospectivestudieslookinginto anevidencebasedalgorithmforlessfrequentrenalfunctionmonitoringthancurrentguidelinerecommendations maybehelpful. Keywords:Tenofovir,Kidney,Antiretrovirals Background Tenofovirdisoproxilfumarate containing ARV regimens showed that TDF use was associatedwithstatisticallysignificantlossofrenalfunc- (TDF) is a nucleotide analogue widely recommended in international HIV tionandtheclinicaleffectwasmodest[15]. treatmentguidelines[1-3]. ThemechanismbywhichTDFcausesrenaltoxicity is The