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Renal function in HIV-infected children and adolescents treated with tenofovir disoproxil fumarate and protease inhibitors.

Pontrelli G, Cotugno N, Amodio D, Zangari P, Tchidjou HK, Baldassari S, Palma P, Bernardi S - BMC Infect. Dis. (2012)

Bottom Line: The median creatinine increased in the entire cohort and in all the groups analyzed; eGFR decreased from 143.6 mL/min/1.73 m2 at baseline to 128.9 after 2 years (p = 0.006) in the entire cohort.Three patients presented a mild eGFR reduction, all were on TDF+PI.Phosphatemia decreased significantly in the entire cohort (p = 0.0003) and in TDF+PI group (p = 0.0128) after 2 years.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Department of Pediatrics, Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165 Rome, Italy. giuseppe.pontrelli@opbg.net

ABSTRACT

Background: Kidney disease is an important complication in HIV infected people, and this may be related to infection or antiretroviral therapy (ART). Our aim is to assess renal function in HIV infected paediatric patients, who may be particularly affected and are likely to take ART for longer than adults, and investigate the long term role of Tenofovir Disoproxil Fumarate (TDF) alone or co-administered with Ritonavir-boosted Protease Inhibitors (PI).

Methods: Serum creatinine, phosphate and potassium levels, with estimated Glomerular Filtration Rate (eGFR), had been prospectively evaluated for 2 years in a cohort of HIV infected children and adolescents (age 9-18) on ART, and data analyzed according to the exposure to TDF or simultaneous TDF and PI.

Results: Forty-nine patients were studied (57% female, mean age 14). Sixty-three percent were treated with ART containing TDF (Group A), and 37% without TDF (Group B); 47% with concomitant use of TDF and PI (Group C) and 53% without this combination (Group D). The groups didn't differ for age, gender or ethnicity. The median creatinine increased in the entire cohort and in all the groups analyzed; eGFR decreased from 143.6 mL/min/1.73 m2 at baseline to 128.9 after 2 years (p = 0.006) in the entire cohort. Three patients presented a mild eGFR reduction, all were on TDF+PI. Phosphatemia decreased significantly in the entire cohort (p = 0.0003) and in TDF+PI group (p = 0.0128) after 2 years. Five patients (10%) developed hypophosphatemia (Division of Acquired Immune Deficiency AE grade 1 or 2), and four of them were on TDF+PI.

Conclusions: Renal function decrease and hypophosphatemia occur over time in HIV infected children and adolescents on ART. The association with co-administration of TDF and PI appears weak, and further studies are warranted.

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Related in: MedlinePlus

Renal function and tubular damage markers, at baseline and after 1 and 2 years, in the entire cohort, and in each treatment group. Patients were grouped according to the exposure to antiretrovirals: Group A = TDF, Group B = no TDF; Group C = TDF+PI, Group D = no TDF+PI. Statistical analysis related to baseline, 1 and 2 years in each group were performed through Friedman test. P-values related to analysis between group A versus group B and group C versus group D at each time point were obtained through Mann Whitney test (*), while those related to analysis between two time points among the same group with Wilcoxon matched-paired signed rank test (#).
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Figure 1: Renal function and tubular damage markers, at baseline and after 1 and 2 years, in the entire cohort, and in each treatment group. Patients were grouped according to the exposure to antiretrovirals: Group A = TDF, Group B = no TDF; Group C = TDF+PI, Group D = no TDF+PI. Statistical analysis related to baseline, 1 and 2 years in each group were performed through Friedman test. P-values related to analysis between group A versus group B and group C versus group D at each time point were obtained through Mann Whitney test (*), while those related to analysis between two time points among the same group with Wilcoxon matched-paired signed rank test (#).

Mentions: As shown in Figure 1, in the entire cohort there was a significant increase of serum creatinine, from a median of 0.62 mg/dL at baseline to 0.73 mg/dL (p < 0.0001) after 2 years; eGFR decrease from a median of 143.6 at baseline to 135.6 at 1 year, and 128.9 ml/min per 1.73 m2 at 2 years (p = 0.006). The value of phosphatemia decreased significantly from 4.4 at baseline to 4.0 at 1 year (p = 0.0301) and to 3.8 mg/dl at 2 years (p = 0.0003). The median of potassiemia in the entire cohort during the study period didn't vary significantly.


Renal function in HIV-infected children and adolescents treated with tenofovir disoproxil fumarate and protease inhibitors.

Pontrelli G, Cotugno N, Amodio D, Zangari P, Tchidjou HK, Baldassari S, Palma P, Bernardi S - BMC Infect. Dis. (2012)

Renal function and tubular damage markers, at baseline and after 1 and 2 years, in the entire cohort, and in each treatment group. Patients were grouped according to the exposure to antiretrovirals: Group A = TDF, Group B = no TDF; Group C = TDF+PI, Group D = no TDF+PI. Statistical analysis related to baseline, 1 and 2 years in each group were performed through Friedman test. P-values related to analysis between group A versus group B and group C versus group D at each time point were obtained through Mann Whitney test (*), while those related to analysis between two time points among the same group with Wilcoxon matched-paired signed rank test (#).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3306735&req=5

Figure 1: Renal function and tubular damage markers, at baseline and after 1 and 2 years, in the entire cohort, and in each treatment group. Patients were grouped according to the exposure to antiretrovirals: Group A = TDF, Group B = no TDF; Group C = TDF+PI, Group D = no TDF+PI. Statistical analysis related to baseline, 1 and 2 years in each group were performed through Friedman test. P-values related to analysis between group A versus group B and group C versus group D at each time point were obtained through Mann Whitney test (*), while those related to analysis between two time points among the same group with Wilcoxon matched-paired signed rank test (#).
Mentions: As shown in Figure 1, in the entire cohort there was a significant increase of serum creatinine, from a median of 0.62 mg/dL at baseline to 0.73 mg/dL (p < 0.0001) after 2 years; eGFR decrease from a median of 143.6 at baseline to 135.6 at 1 year, and 128.9 ml/min per 1.73 m2 at 2 years (p = 0.006). The value of phosphatemia decreased significantly from 4.4 at baseline to 4.0 at 1 year (p = 0.0301) and to 3.8 mg/dl at 2 years (p = 0.0003). The median of potassiemia in the entire cohort during the study period didn't vary significantly.

Bottom Line: The median creatinine increased in the entire cohort and in all the groups analyzed; eGFR decreased from 143.6 mL/min/1.73 m2 at baseline to 128.9 after 2 years (p = 0.006) in the entire cohort.Three patients presented a mild eGFR reduction, all were on TDF+PI.Phosphatemia decreased significantly in the entire cohort (p = 0.0003) and in TDF+PI group (p = 0.0128) after 2 years.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Department of Pediatrics, Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165 Rome, Italy. giuseppe.pontrelli@opbg.net

ABSTRACT

Background: Kidney disease is an important complication in HIV infected people, and this may be related to infection or antiretroviral therapy (ART). Our aim is to assess renal function in HIV infected paediatric patients, who may be particularly affected and are likely to take ART for longer than adults, and investigate the long term role of Tenofovir Disoproxil Fumarate (TDF) alone or co-administered with Ritonavir-boosted Protease Inhibitors (PI).

Methods: Serum creatinine, phosphate and potassium levels, with estimated Glomerular Filtration Rate (eGFR), had been prospectively evaluated for 2 years in a cohort of HIV infected children and adolescents (age 9-18) on ART, and data analyzed according to the exposure to TDF or simultaneous TDF and PI.

Results: Forty-nine patients were studied (57% female, mean age 14). Sixty-three percent were treated with ART containing TDF (Group A), and 37% without TDF (Group B); 47% with concomitant use of TDF and PI (Group C) and 53% without this combination (Group D). The groups didn't differ for age, gender or ethnicity. The median creatinine increased in the entire cohort and in all the groups analyzed; eGFR decreased from 143.6 mL/min/1.73 m2 at baseline to 128.9 after 2 years (p = 0.006) in the entire cohort. Three patients presented a mild eGFR reduction, all were on TDF+PI. Phosphatemia decreased significantly in the entire cohort (p = 0.0003) and in TDF+PI group (p = 0.0128) after 2 years. Five patients (10%) developed hypophosphatemia (Division of Acquired Immune Deficiency AE grade 1 or 2), and four of them were on TDF+PI.

Conclusions: Renal function decrease and hypophosphatemia occur over time in HIV infected children and adolescents on ART. The association with co-administration of TDF and PI appears weak, and further studies are warranted.

Show MeSH
Related in: MedlinePlus