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|Title: ||Tenofovir is associated with increased tubular proteinuria and asymptomatic renal tubular dysfunction in Ghana|
|Authors: ||Chadwick, David R.|
Sarfo, Fred Stephen
Kirk, Elaine S. M.
Owusu, Ann Lorraine
|Issue Date: ||2015|
|Publisher: ||BMC Nephrology|
|Citation: ||BMC Nephrology (2015) 16:195; DOI 10.1186/s12882-015-0192-4|
|Abstract: ||Background: HIV infection is associated with increased risk of renal dysfunction, including tubular dysfunction (TD)
related to antiretroviral therapy (ART). Tenofovir disoproxil fumarate (TDF) is becoming available for ART in sub-
Saharan Africa, although data on its long-term safety there is limited. We aimed to study the prevalence of HIVassociated
renal dysfunction in Ghana and explore associations between proteinuria or TD and potential risk factors,
including TDF use.
Methods: A single-centre cross-sectional observational study of patients taking ART was undertaken. Creatinine
clearance (CrCl) was calculated and proteinuria detected with dipsticks. Spot urinary albumin and protein:creatinine
ratios (uACR/uPCR) were measured and further evidence of TD (defined as having two or more characteristic
features) sought. Logistic regression analysis identified factors associated with proteinuria or TD.
Results: In 330 patients, of whom 101 were taking TDF (median 20 months), the prevalence of CrCl < 60ml/min/
1.73m2, dipstick proteinuria and TD was 7 %, 37 % and 15 %. Factors associated with proteinuria were baseline
CD4-count [aOR 0.86/100 cell increment (95 % CI, 0.74–0.99)] and TDF use [aOR 2.74 (95 % CI, 1.38–5.43)]. The only
factor associated with TD was TDF use [aOR 3.43 (95 % CI, 1.10–10.69)]. In a subset with uPCR measurements, uPCRs
were significantly higher in patients taking TDF than those on other drugs (10.8 vs. 5.7 mg/mmol, p < 0.001), and
urinary albuin:protein ratios significantly lower (0.24 vs. 0.58, p < 0.001).
Conclusions: Both proteinuria and TD are common and associated with TDF use in Ghana. Further longitudinal
studies to determine whether proteinuria, TD or TDF use are linked to progressive decline in renal function or other
adverse outcomes are needed in Africa.|
|Description: ||An article published in BMC Nephrology (2015) 16:195; DOI 10.1186/s12882-015-0192-4|
|Appears in Collections:||College of Health Sciences|
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