Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania
Background: Kidney disease is a growing non-AIDS-related comorbidity among people living with HIV (PLWH). Tenofovir disoproxil fumarate (TDF) can result in proximal tubulopathy and acute tubular injury, whereas atazanavir/ritonavir (ATV/r) can cause interstitial nephritis and renal stones, both of w...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2025-01-01
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| Series: | Southern African Journal of HIV Medicine |
| Subjects: | |
| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/1640 |
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| Summary: | Background: Kidney disease is a growing non-AIDS-related comorbidity among people living with HIV (PLWH). Tenofovir disoproxil fumarate (TDF) can result in proximal tubulopathy and acute tubular injury, whereas atazanavir/ritonavir (ATV/r) can cause interstitial nephritis and renal stones, both of which can lead to chronic kidney disease.
Objectives: To examine the relationship between second-line combination antiretroviral therapy (ART) and the risk of kidney disease and morphological changes among PLWH in Dar es Salaam, Tanzania.
Method: A cross-sectional study of adult PLWH receiving TDF-based second-line ART. Socio-demographic and clinical data were gathered, and laboratory tests were conducted to determine the estimated glomerular filtration rate (eGFR). Ultrasonography was performed to visualise the kidneys.
Results: A total of 323 patients were enrolled (67.8% women), with a median age of 44 (interquartile range [IQR]: 39–51) years. Patients were on second-line ART for a median of 49 [IQR: 25–73] months, and 60% received ATV/r. Low eGFR ( 90 mL/min per 1.73 m2) was found in 22% of patients, proportionately higher among patients on ATV/r compared to those on a lopinavir/ritonavir (LPV/r) (P 0.05). Nearly one-third (32.2%) of patients had a triad of renal calcinosis, renal calculi, and nephritis on ultrasonography. Patients using ATV/r had significantly smaller kidney volumes and greater proportions of renal calculi and nephritis compared to those on LPV/r (P 0.05).
Conclusion: Adults on second-line ART containing TDF were found to have a high prevalence of renal kidney disease in the Tanzanian context. Predictors of kidney disease were older age, proteinuria, and ATV/r-based regimen as compared to LPV/r. |
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| ISSN: | 1608-9693 2078-6751 |