Duration of tenofovir disoproxil fumarate treatment and a rapid eGFR decline in a retrospective cohort of people living with HIV infection

Background Tenofovir disoproxil fumarate (TDF) is one of the first-line antiretroviral therapies in patients with HIV infection. It may be associated with renal impairment. This study aimed to evaluate risk factors for a rapid decline in estimated glomerular filtration rate (eGFR) in patients with HIV infection treated with a TDF-based regimen. Methods This was a retrospective cohort study conducted in adult patients with HIV infection who were aged 18 years or older, had a baseline eGFR of 90 ml/min/1.73m 2 , and were treated at an HIV clinic with TDF. The primary outcome of this study was a decline in eGFR of 5 or more ml/min/1.73m 2 with stable or deteriorating eGFR in the following year. Predictors of rapid eGFR decline were calculated by logistic regression analysis. Results A total of 533 patients with HIV infection met the study criteria. Of those, 174 patients (32.65%) experienced an eGFR decline of 5 ml/min/1.73m 2 or more after treatment with TDF. The average follow-up time was 7.94 years (SD 1.80). Four factors were identified in the predictive model for a decline in eGFR of 5 or more ml/min/1.73m 2 , including age, hepatitis B virus infection, urine albumin-to-creatinine ratio, and duration of TDF treatment. Only duration of TDF treatment was independently associated with a decline in eGFR of 5 or more ml/min/1.73m 2 , with an adjusted odds ratio of 1.188 (95% confidence interval: 1.063–1.328). Conclusion This long-term cohort study of patients with HIV infection treated with TDF showed that duration of TDF treatment may be associated with a rapid decline in eGFR. Annual monitoring of eGFR is warranted.