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Renal impairment after switching from stavudine/lamivudine to tenofovir/lamivudine in NNRTI-based antiretroviral regimens.

Manosuthi W, Mankatitham W, Lueangniyomkul A, Prasithsirikul W, Tantanathip P, Suntisuklappon B, Narkksoksung A, Nilkamhang S, Sungkanuparph S - AIDS Res Ther (2010)

Bottom Line: By multivariate analysis, 'receiving nevirapine', 'old age' and 'low baseline serum phosphorus' were associated with hypophosphatemia at 24 weeks (P < 0.05).Receiving nevirapine and low baseline eGFR were associated with lower eGFR at 24 weeks (P < 0.05).The frequency of tenofovir-associated renal impairment was higher in patients receiving tenofovir/lamivudine/nevirapine compared to tenofovir/lamivudine/efavirenz.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand. drweerawat@hotmail.com.

ABSTRACT

Background: During stavudine phase-out plan in developing countries, tenofovir is used to substitute stavudine. However, knowledge regarding whether there is any difference of the frequency of renal injury between tenofovir/lamivudine/efavirenz and tenofovir/lamivudine/nevirapine is lacking.

Methods: This prospective study was conducted among HIV-infected patients who were switched NRTI from stavudine/lamivudine to tenofovir/lamivudine in efavirenz-based (EFV group) and nevirapine-based regimen (NVP group) after two years of an ongoing randomized trial. All patients were assessed for serum phosphorus, uric acid, creatinine, estimated glomerular filtration rate (eGFR), and urinalysis at time of switching, 12 and 24 weeks.

Results: Of 62 patients, 28 were in EFV group and 34 were in NVP group. Baseline characteristics and eGFR were not different between two groups. At 12 weeks, comparing mean ± SD measures between EFV group and NVP group were: phosphorus of 3.16 ± 0.53 vs. 2.81 ± 0.42 mg/dL (P = 0.005), %patients with proteinuria were 15% vs. 38% (P = 0.050). At 24 weeks, mean ± SD phosphorus and median (IQR) eGFR between the corresponding groups were 3.26 ± 0.78 vs. 2.84 ± 0.47 mg/dL (P = 0.011) and 110 (99-121) vs. 98 (83-112) mL/min (P = 0.008). In NVP group, comparing week 12 to time of switching, there was a decrement of phosphorus (P = 0.007) and eGFR (P = 0.034). By multivariate analysis, 'receiving nevirapine', 'old age' and 'low baseline serum phosphorus' were associated with hypophosphatemia at 24 weeks (P < 0.05). Receiving nevirapine and low baseline eGFR were associated with lower eGFR at 24 weeks (P < 0.05).

Conclusion: The frequency of tenofovir-associated renal impairment was higher in patients receiving tenofovir/lamivudine/nevirapine compared to tenofovir/lamivudine/efavirenz. Further studies regarding patho-physiology are warranted.

No MeSH data available.


Related in: MedlinePlus

Relationship between age of patients and combined serum phosphorus levels at week 12 and 24 after NRTI switching. Lines represent regression prediction and 95 percent confidence intervals for the mean. Unfilled dot represents serum phosphorus in the EFV group; and filled dot represents serum phosphorus in the NVP group.
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Figure 3: Relationship between age of patients and combined serum phosphorus levels at week 12 and 24 after NRTI switching. Lines represent regression prediction and 95 percent confidence intervals for the mean. Unfilled dot represents serum phosphorus in the EFV group; and filled dot represents serum phosphorus in the NVP group.

Mentions: Table 2 and table 3 showed univariate and multivariate analysis of possible predicted factors that associated with low serum phosphorus and those associated with low eGFR at week 24 after NRTI switching. By multivariate analysis, three factors; included 'concurrent receiving nevirapine', 'old age' and 'low baseline serum phosphorus', were associated with low serum phosphorus level after 24 weeks of switching stavudine to tenofovir (P < 0.05). The factors 'concurrent receiving nevirapine' and 'low baseline eGFR' were associated with low eGFR at week 24 (P < 0.05). Relationship between age of patients and combined serum phosphorus levels at week 12 and 24 after NRTI switching is depicted in figure 3. The same trends were found at week 12 (P < 0.001, r = -0.540) and week 24 (P < 0.001, r = -0.434). At week 24, none of the patients experienced virological rebound or drug interruption.


Renal impairment after switching from stavudine/lamivudine to tenofovir/lamivudine in NNRTI-based antiretroviral regimens.

Manosuthi W, Mankatitham W, Lueangniyomkul A, Prasithsirikul W, Tantanathip P, Suntisuklappon B, Narkksoksung A, Nilkamhang S, Sungkanuparph S - AIDS Res Ther (2010)

Relationship between age of patients and combined serum phosphorus levels at week 12 and 24 after NRTI switching. Lines represent regression prediction and 95 percent confidence intervals for the mean. Unfilled dot represents serum phosphorus in the EFV group; and filled dot represents serum phosphorus in the NVP group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3020664&req=5

Figure 3: Relationship between age of patients and combined serum phosphorus levels at week 12 and 24 after NRTI switching. Lines represent regression prediction and 95 percent confidence intervals for the mean. Unfilled dot represents serum phosphorus in the EFV group; and filled dot represents serum phosphorus in the NVP group.
Mentions: Table 2 and table 3 showed univariate and multivariate analysis of possible predicted factors that associated with low serum phosphorus and those associated with low eGFR at week 24 after NRTI switching. By multivariate analysis, three factors; included 'concurrent receiving nevirapine', 'old age' and 'low baseline serum phosphorus', were associated with low serum phosphorus level after 24 weeks of switching stavudine to tenofovir (P < 0.05). The factors 'concurrent receiving nevirapine' and 'low baseline eGFR' were associated with low eGFR at week 24 (P < 0.05). Relationship between age of patients and combined serum phosphorus levels at week 12 and 24 after NRTI switching is depicted in figure 3. The same trends were found at week 12 (P < 0.001, r = -0.540) and week 24 (P < 0.001, r = -0.434). At week 24, none of the patients experienced virological rebound or drug interruption.

Bottom Line: By multivariate analysis, 'receiving nevirapine', 'old age' and 'low baseline serum phosphorus' were associated with hypophosphatemia at 24 weeks (P < 0.05).Receiving nevirapine and low baseline eGFR were associated with lower eGFR at 24 weeks (P < 0.05).The frequency of tenofovir-associated renal impairment was higher in patients receiving tenofovir/lamivudine/nevirapine compared to tenofovir/lamivudine/efavirenz.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand. drweerawat@hotmail.com.

ABSTRACT

Background: During stavudine phase-out plan in developing countries, tenofovir is used to substitute stavudine. However, knowledge regarding whether there is any difference of the frequency of renal injury between tenofovir/lamivudine/efavirenz and tenofovir/lamivudine/nevirapine is lacking.

Methods: This prospective study was conducted among HIV-infected patients who were switched NRTI from stavudine/lamivudine to tenofovir/lamivudine in efavirenz-based (EFV group) and nevirapine-based regimen (NVP group) after two years of an ongoing randomized trial. All patients were assessed for serum phosphorus, uric acid, creatinine, estimated glomerular filtration rate (eGFR), and urinalysis at time of switching, 12 and 24 weeks.

Results: Of 62 patients, 28 were in EFV group and 34 were in NVP group. Baseline characteristics and eGFR were not different between two groups. At 12 weeks, comparing mean ± SD measures between EFV group and NVP group were: phosphorus of 3.16 ± 0.53 vs. 2.81 ± 0.42 mg/dL (P = 0.005), %patients with proteinuria were 15% vs. 38% (P = 0.050). At 24 weeks, mean ± SD phosphorus and median (IQR) eGFR between the corresponding groups were 3.26 ± 0.78 vs. 2.84 ± 0.47 mg/dL (P = 0.011) and 110 (99-121) vs. 98 (83-112) mL/min (P = 0.008). In NVP group, comparing week 12 to time of switching, there was a decrement of phosphorus (P = 0.007) and eGFR (P = 0.034). By multivariate analysis, 'receiving nevirapine', 'old age' and 'low baseline serum phosphorus' were associated with hypophosphatemia at 24 weeks (P < 0.05). Receiving nevirapine and low baseline eGFR were associated with lower eGFR at 24 weeks (P < 0.05).

Conclusion: The frequency of tenofovir-associated renal impairment was higher in patients receiving tenofovir/lamivudine/nevirapine compared to tenofovir/lamivudine/efavirenz. Further studies regarding patho-physiology are warranted.

No MeSH data available.


Related in: MedlinePlus