Commonly used tenofovir, a nucleootide reverse transcriptase inhibitor (NRTI) used in anti-retroviral therapy (ART) is associated with declines in renal function, according to researchers at the Kaiser Permanente Division of Research in Oakland, CA. The study appears in the current online version of The Journal of Acquired Immune Deficiency Syndrome.
The potential long-term toxic effects of tenofovir on renal function have not been widely studied in large clinical and managed care cohorts, according to the authors.
“This study, which looks at a population of patients in a large integrated care delivery system, indicates that there is a statistically significant effect of tenofovir on renal function in patients who have never been on antiretroviral medications previously and are now initiating antiretroviral therapy,” said Michael Horberg, director of HIV/AIDS for Kaiser Permanente and lead researcher for this study. He added that the researchers also found that tenofovir exposure was associated with a great risk of developing proximal tubular dysfunction, another potential harm to the kidneys.
“The potential long-term adverse affects on kidney function may limit use of tenofovir for patients risk for renal complications. Also, long-term monitoring of renal function and proximal tubular dysfunction in patients taking tenofovir should be considered.”
Researchers performed a retrospective cohort analysis of HIV infected patients in California, Maryland, Virginia and the District of Columbia. All were Kaiser Permanente patients initiating a first ART regimen from January 2002 through December 2005. While the researchers note that this topic warrants additional longer-term studies, the study is significant for its patient population size, persistence of the adverse renal effects over time, and the ability to control for a variety of co-founders potentially associated with renal dysfunction, such as patient demographics, co-morbidities and other medications prescribed.
Additional authors on the study include Beth Tang, MA, with the Kaiser Permanente Center for Research and evaluation; William Towner, MD, an HIV Medicine specialist at Kaiser Permanente in Los Angeles, CA; Michael Silverberg, PHD, with the Kaiser Permanente Division of Research; Susan Bersoff-Matcha, MD, with the department of infectious diseases at Kaiser Permanente in Rockville Maryland; Leo Hurley, MPH, with the Kaiser Permanente Division of Research; Joseph Chang, PharmD, with Kaiser Permanente in Los Angeles; Jackie Blank, MBA, with Kaiser Permanente in Rockville Maryland; Charles Quesenberry, PhD, with the Kaiser Permanente Division of Research; and Daniel Klein, MD, with the department of infectious diseases at Kaiser Permanente in Hayward, CA. Funding for this study was provided by Gilead Sciences, Inc.
About the Kaiser Permanente Division of Research (https://www.dor.kaiser.org/)
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 400-plus staff is working on more than 250 epidemiological and health services research projects.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.