Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program
Tenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney disease (CKD), especially in Asian populations. Data from the Thai national health insurance system was used to assess CKD incidence in patients receiving antiretroviral therapy in real-world practice. We analyzed data f...
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MDPI AG
2022-08-01
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| Online Access: | https://www.mdpi.com/2227-9032/10/8/1490 |
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| author | Ninutcha Paengsai Kajohnsak Noppakun Gonzague Jourdain Tim Roy Cressey Nicolas Salvadori Romanee Chaiwarith Apichat Tantraworasin Jean Yves Mary Chureeratana Bowonwatanuwong Sorakij Bhakeecheep Patrinee Traisathit Natapong Kosachunhanun |
| author_facet | Ninutcha Paengsai Kajohnsak Noppakun Gonzague Jourdain Tim Roy Cressey Nicolas Salvadori Romanee Chaiwarith Apichat Tantraworasin Jean Yves Mary Chureeratana Bowonwatanuwong Sorakij Bhakeecheep Patrinee Traisathit Natapong Kosachunhanun |
| author_sort | Ninutcha Paengsai |
| collection | DOAJ |
| description | Tenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney disease (CKD), especially in Asian populations. Data from the Thai national health insurance system was used to assess CKD incidence in patients receiving antiretroviral therapy in real-world practice. We analyzed data from patients who initiated one of the following first-line regimens: zidovudine + lamivudine + nevirapine (AZT + 3TC + NVP); zidovudine + lamivudine + efavirenz (AZT + 3TC + EFV); tenofovir + lamivudine + nevirapine (TDF + 3TC + NVP); tenofovir + lamivudine/emtricitabine + efavirenz (TDF + 3TC/FTC + EFV); and tenofovir +lamivudine +lopinavir/ritonavir (TDF + 3TC + LPV/r). CKD was defined as glomerular filtration rate <60 mL/min/1.73 m<sup>2</sup> for >3 months, or a confirmed 2010 WHO diagnosis (ICD-10 code N183, N184, or N185). Death competing risk survival regression models were used. Among 27,313 participants, with a median age of 36.8 years and median follow-up of 2.3 years, 245 patients (0.9%) were diagnosed with CKD (incidence 3.2 per 1000 patient-years; 95% CI 2.8–3.6). Compared with patients receiving AZT + 3TC + NVP, the risk of CKD measured by adjusted sub-distribution hazard ratio (aSHR) was 6.5 (95% CI 3.9–11.1) in patients on TDF + 3TC + LPV/r, 3.8 (95% CI 2.3–6.0) in TDF + 3TC + NVP, and 1.6 (95% CI 1.2–2.3) in TDF + 3TC/FTC + EFV. Among patients receiving TDF, compared with those receiving TDF + 3TC/FTC + EFV, the aSHR was 4.0 (95% CI 2.3–6.8) in TDF + 3TC + LPV/r and 2.3 (95% CI 1.4–3.6) in TDF + 3TC + NVP. TDF was associated with an increased risk of CKD, especially when combined with LPV/r or NVP. |
| first_indexed | 2024-03-09T13:21:43Z |
| format | Article |
| id | doaj.art-c24278176b3d4b91963653eacd3b6cac |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-09T13:21:43Z |
| publishDate | 2022-08-01 |
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| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-c24278176b3d4b91963653eacd3b6cac2023-11-30T21:29:55ZengMDPI AGHealthcare2227-90322022-08-01108149010.3390/healthcare10081490Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment ProgramNinutcha Paengsai0Kajohnsak Noppakun1Gonzague Jourdain2Tim Roy Cressey3Nicolas Salvadori4Romanee Chaiwarith5Apichat Tantraworasin6Jean Yves Mary7Chureeratana Bowonwatanuwong8Sorakij Bhakeecheep9Patrinee Traisathit10Natapong Kosachunhanun11Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandDivision of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandInstitut de Recherche pour le Développement (IRD), MIVEGEC, 13002 Marseille, FranceInstitut de Recherche pour le Développement (IRD), MIVEGEC, 13002 Marseille, FranceInstitut de Recherche pour le Développement (IRD), MIVEGEC, 13002 Marseille, FranceDivision of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandClinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandINSERM UMR 1135, Equipe ECSTRRA, Centre de Recherche Epidémiologie Statistique Sorbonne Paris Cité, Université Paris Diderot, 75004 Paris, FranceDepartment of Internal Medicine, Chonburi Hospital, Chonburi 20000, ThailandSchool of Medicine, University of Phayao, Phayao 56000, ThailandData Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, ThailandDivision of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandTenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney disease (CKD), especially in Asian populations. Data from the Thai national health insurance system was used to assess CKD incidence in patients receiving antiretroviral therapy in real-world practice. We analyzed data from patients who initiated one of the following first-line regimens: zidovudine + lamivudine + nevirapine (AZT + 3TC + NVP); zidovudine + lamivudine + efavirenz (AZT + 3TC + EFV); tenofovir + lamivudine + nevirapine (TDF + 3TC + NVP); tenofovir + lamivudine/emtricitabine + efavirenz (TDF + 3TC/FTC + EFV); and tenofovir +lamivudine +lopinavir/ritonavir (TDF + 3TC + LPV/r). CKD was defined as glomerular filtration rate <60 mL/min/1.73 m<sup>2</sup> for >3 months, or a confirmed 2010 WHO diagnosis (ICD-10 code N183, N184, or N185). Death competing risk survival regression models were used. Among 27,313 participants, with a median age of 36.8 years and median follow-up of 2.3 years, 245 patients (0.9%) were diagnosed with CKD (incidence 3.2 per 1000 patient-years; 95% CI 2.8–3.6). Compared with patients receiving AZT + 3TC + NVP, the risk of CKD measured by adjusted sub-distribution hazard ratio (aSHR) was 6.5 (95% CI 3.9–11.1) in patients on TDF + 3TC + LPV/r, 3.8 (95% CI 2.3–6.0) in TDF + 3TC + NVP, and 1.6 (95% CI 1.2–2.3) in TDF + 3TC/FTC + EFV. Among patients receiving TDF, compared with those receiving TDF + 3TC/FTC + EFV, the aSHR was 4.0 (95% CI 2.3–6.8) in TDF + 3TC + LPV/r and 2.3 (95% CI 1.4–3.6) in TDF + 3TC + NVP. TDF was associated with an increased risk of CKD, especially when combined with LPV/r or NVP.https://www.mdpi.com/2227-9032/10/8/1490antiretroviral therapychronic kidney diseaseHIV infectiontenofovir disoproxil fumarate |
| spellingShingle | Ninutcha Paengsai Kajohnsak Noppakun Gonzague Jourdain Tim Roy Cressey Nicolas Salvadori Romanee Chaiwarith Apichat Tantraworasin Jean Yves Mary Chureeratana Bowonwatanuwong Sorakij Bhakeecheep Patrinee Traisathit Natapong Kosachunhanun Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program Healthcare antiretroviral therapy chronic kidney disease HIV infection tenofovir disoproxil fumarate |
| title | Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program |
| title_full | Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program |
| title_fullStr | Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program |
| title_full_unstemmed | Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program |
| title_short | Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program |
| title_sort | chronic kidney disease in a large national human immunodeficiency virus treatment program |
| topic | antiretroviral therapy chronic kidney disease HIV infection tenofovir disoproxil fumarate |
| url | https://www.mdpi.com/2227-9032/10/8/1490 |
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