PrEP is an effective strategy for preventing HIV infection. However, some studies associate tenofovir disoproxil fumarate (TDF) with reduced glomerular filtration rate (GFR) and other renal adverse effects, such as proteinuria and progression to chronic kidney disease (CKD). This study aimed to evaluate the incidence of renal dysfunction among PrEP users at an Infectious Diseases outpatient clinic of a tertiary hospital in Paraná. Observational, prospective study of PrEP users, March 2023–March 2025. A ≥ 10% decline in GFR between months 4–8 and at 12 months of follow-up was assessed relative to baseline GFR. GFR was calculated from serum creatinine using the CKD-EPI 2021 equation. Patients without at least two GFR measurements were excluded. Protein/creatinine ratio was not analyzed due to unavailability in most records. CKD was defined as GFR < 60 mL/min/1.73 m² on two measurements three months apart. Of 109 patients in follow-up, 68 were eligible for analysis. A ≥ 10% GFR reduction between months 4–8 of PrEP use occurred in 23.5% (16/68). At month 12, only 13.2% (9/68) maintained a ≥ 10% GFR loss. Considering only those with a creatinine at month 12, 29% (9/31) had ≥ 10% GFR decline. During follow-up, only two patients had GFR < 60 mL/min/1.73 m²: one used creatine supplements (no alternative assessment to exclude confounding), and the other was lost to follow-up after the second creatinine, preventing CKD classification or a causal link to TDF. There was a low incidence of GFR loss at 12 months after PrEP initiation, supporting the renal safety of TDF in PrEP users and aligning with other published cohorts. In cases progressing to CKD, patient age group and comorbidities should be evaluated as potential contributors.
Carneiro et al. (Sun,) studied this question.