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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| Format: | Article |
| Language: | English |
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AOSIS
2025-01-01
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| Series: | Southern African Journal of HIV Medicine |
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| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/1640 |
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| author | Sabina F. Mugusi Grace A. Shayo Philip G. Sasi Lulu S. Fundikira Eric A. Aris Christopher R. Sudfeld Ferdinand M. Mugusi |
| author_facet | Sabina F. Mugusi Grace A. Shayo Philip G. Sasi Lulu S. Fundikira Eric A. Aris Christopher R. Sudfeld Ferdinand M. Mugusi |
| author_sort | Sabina F. Mugusi |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-028f5e887f7c4bc19eed2fbe8913ae38 |
| institution | Kabale University |
| issn | 1608-9693 2078-6751 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj-art-028f5e887f7c4bc19eed2fbe8913ae382025-02-11T13:28:52ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512025-01-01261e1e810.4102/sajhivmed.v26i1.1640889Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, TanzaniaSabina F. Mugusi0Grace A. Shayo1Philip G. Sasi2Lulu S. Fundikira3Eric A. Aris4Christopher R. Sudfeld5Ferdinand M. Mugusi6Department of Clinical Pharmacology, School of Biomedical Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania; and Department of Global Health and Population, Harvard T.H. Chan School of Public Health, BostonDepartment of Internal Medicine, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es SalaamDepartment of Clinical Pharmacology, School of Biomedical Sciences, Muhimbili University of Health and Allied Sciences, Dar es SalaamDepartment of Radiology and Imaging, School of Diagnostic Medicine, Muhimbili University of Health and Allied Sciences, Dar es SalaamManagement and Development for Health, Dar es SalaamDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, BostonDepartment of Internal Medicine, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es SalaamBackground: 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.https://sajhivmed.org.za/index.php/hivmed/article/view/1640hivcombination antiretroviral therapykidney diseasetenofoviratazanavir sulfate |
| spellingShingle | Sabina F. Mugusi Grace A. Shayo Philip G. Sasi Lulu S. Fundikira Eric A. Aris Christopher R. Sudfeld Ferdinand M. Mugusi Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania Southern African Journal of HIV Medicine hiv combination antiretroviral therapy kidney disease tenofovir atazanavir sulfate |
| title | Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania |
| title_full | Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania |
| title_fullStr | Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania |
| title_full_unstemmed | Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania |
| title_short | Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania |
| title_sort | kidney disease among adults on tenofovir based second line antiretroviral therapy in dar es salaam tanzania |
| topic | hiv combination antiretroviral therapy kidney disease tenofovir atazanavir sulfate |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/1640 |
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