Background Tenofovir (TDF) is used in combination for first-line treatment in HIV infection due to its efficacy and tolerability. However, the use of TDF may be associated with renal toxicity, so it is recommended to tailor the dose in patients with CrCl < 50 mL/min.
Purpose To determine the number of patients receiving TDF with CrCl < 50 mL/min, and to evaluate whether dose adjustment is being performed properly in accordance with the recommendations.
Material and methods A retrospective and observational study in HIV-infected adult patients treated with TDF (January 2010–December 2012) was carried out in a tertiary General Hospital (600 beds). The Inclusion criteria were: baseline normal CrCl, more than six months on TDF treatment and three CrCl determinations. Potential risk factors analysed were: age, gender, baseline CD4 and HIV RNA, previous treatment, comorbidities and use of co-formulated presentation. The CrCl was calculated using the MDRD formula. The prevalence of renal insufficiency (CrCl < 50 mL/min) and the degree of compliance with the GESIDA guidelines (300 mg/48 h for patients with CrCl < 50 mL/min and 300 mg/72–96 h for patients with CrCl < 30 mL/min) were calculated.
Results 451 patients were included (68.2% male, mean age = 46.2 ± 8.2 years). 4.8% of patients had renal impairment with CrCl < 50 mL/min. 14% of patients had CrCl < 30 mL/min. The comorbidity rates were: 40.9% hypertension, 63.6% hepatitis C co-infection and 54.5% were smokers. Mean number of treatment lines prior to TDF was 2.4 ± 2.1.
59.1% of patients were treated with combined TDF and boosted protease inhibitor (PI) treatment. 100% of patients used a co-formulated TDF presentation.
No doses were tailored in any patients according to renal impairment, while 40% of patients changed the treatment to TDF-free combinations.
Conclusion Patients on treatment with TDF rarely need a dose adjustment due to renal impairment. Moreover, the dose was not adjusted for any patients with renal impairment, while a change of treatment was preferred.
References and/or Acknowledgements
GeSIDA/National AIDS Plan: Consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus
References and/or AcknowledgementsNo conflict of interest.
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