Tenofovir is associated with increased tubular proteinuria and asymptomatic renal tubular dysfunction in Ghana
Identifieur interne : 000266 ( Main/Exploration ); précédent : 000265; suivant : 000267Tenofovir is associated with increased tubular proteinuria and asymptomatic renal tubular dysfunction in Ghana
Auteurs : David R. Chadwick ; Fred S. Sarfo [Ghana] ; Elaine S. M. Kirk ; Dorcas Owusu [Ghana] ; George Bedu-Addo [Ghana] ; Victoria Parris ; Ann Lorraine Owusu [Royaume-Uni] ; Richard Phillips [Ghana]Source :
- BMC Nephrology [ 1471-2369 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Agents antiVIH (effets indésirables), Agents antiVIH (usage thérapeutique), Antiviraux, Causalité, Comorbidité, Effets secondaires indésirables des médicaments (épidémiologie), Effets secondaires indésirables des médicaments (étiologie), Femelle, Ghana (épidémiologie), Humains, Infections à VIH (traitement médicamenteux), Infections à VIH (épidémiologie), Maladies du rein (), Maladies du rein (épidémiologie), Mâle, Protéinurie (), Protéinurie (épidémiologie), Prévalence, Ténofovir (effets indésirables), Ténofovir (usage thérapeutique), Évaluation des risques.
- MESH :
- effets indésirables : Agents antiVIH, Ténofovir.
- traitement médicamenteux : Infections à VIH.
- usage thérapeutique : Agents antiVIH, Ténofovir.
- épidémiologie : Effets secondaires indésirables des médicaments, Ghana, Infections à VIH, Maladies du rein, Protéinurie.
- étiologie : Effets secondaires indésirables des médicaments.
- Adulte, Adulte d'âge moyen, Antiviraux, Causalité, Comorbidité, Femelle, Humains, Maladies du rein, Mâle, Protéinurie, Prévalence, Évaluation des risques.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- Adult, Anti-HIV Agents (adverse effects), Anti-HIV Agents (therapeutic use), Antiviral Agents, Causality, Comorbidity, Drug-Related Side Effects and Adverse Reactions (epidemiology), Drug-Related Side Effects and Adverse Reactions (etiology), Female, Ghana (epidemiology), HIV Infections (drug therapy), HIV Infections (epidemiology), Humans, Kidney Diseases (chemically induced), Kidney Diseases (epidemiology), Male, Middle Aged, Prevalence, Proteinuria (chemically induced), Proteinuria (epidemiology), Risk Assessment, Tenofovir (adverse effects), Tenofovir (therapeutic use).
- MESH :
- chemical , adverse effects : Anti-HIV Agents, Tenofovir.
- chemical , therapeutic use : Anti-HIV Agents, Tenofovir.
- geographic , epidemiology : Ghana.
- chemically induced : Kidney Diseases, Proteinuria.
- drug therapy : HIV Infections.
- epidemiology : Drug-Related Side Effects and Adverse Reactions, HIV Infections, Kidney Diseases, Proteinuria.
- etiology : Drug-Related Side Effects and Adverse Reactions.
- Adult, Antiviral Agents, Causality, Comorbidity, Female, Humans, Male, Middle Aged, Prevalence, Risk Assessment.
Abstract
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 HIV-associated renal dysfunction in Ghana and explore associations between proteinuria or TD and potential risk factors, including TDF use.
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.
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
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.
Url:
DOI: 10.1186/s12882-015-0192-4
PubMed: 26627687
PubMed Central: 4666076
Affiliations:
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Chadwick</name><affiliation><nlm:aff id="Aff1">Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, TS4 3BW UK</nlm:aff><wicri:noCountry code="subfield">TS4 3BW UK</wicri:noCountry></affiliation></author><author><name sortKey="Sarfo, Fred S" sort="Sarfo, Fred S" uniqKey="Sarfo F" first="Fred S." last="Sarfo">Fred S. Sarfo</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Kwame Nkrumah University of Science & Technology, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kwame Nkrumah University of Science & Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff3">Komfo Anokye Teaching Hospital, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Kirk, Elaine S M" sort="Kirk, Elaine S M" uniqKey="Kirk E" first="Elaine S. M." last="Kirk">Elaine S. M. Kirk</name><affiliation><nlm:aff id="Aff1">Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, TS4 3BW UK</nlm:aff><wicri:noCountry code="subfield">TS4 3BW UK</wicri:noCountry></affiliation></author><author><name sortKey="Owusu, Dorcas" sort="Owusu, Dorcas" uniqKey="Owusu D" first="Dorcas" last="Owusu">Dorcas Owusu</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Kwame Nkrumah University of Science & Technology, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kwame Nkrumah University of Science & Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Bedu Addo, George" sort="Bedu Addo, George" uniqKey="Bedu Addo G" first="George" last="Bedu-Addo">George Bedu-Addo</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Kwame Nkrumah University of Science & Technology, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kwame Nkrumah University of Science & Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff3">Komfo Anokye Teaching Hospital, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Parris, Victoria" sort="Parris, Victoria" uniqKey="Parris V" first="Victoria" last="Parris">Victoria Parris</name><affiliation><nlm:aff id="Aff1">Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, TS4 3BW UK</nlm:aff><wicri:noCountry code="subfield">TS4 3BW UK</wicri:noCountry></affiliation></author><author><name sortKey="Owusu, Ann Lorraine" sort="Owusu, Ann Lorraine" uniqKey="Owusu A" first="Ann Lorraine" last="Owusu">Ann Lorraine Owusu</name><affiliation wicri:level="1"><nlm:aff id="Aff4">University of Leicester, Leicester, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Leicester, Leicester</wicri:regionArea><wicri:noRegion>Leicester</wicri:noRegion></affiliation></author><author><name sortKey="Phillips, Richard" sort="Phillips, Richard" uniqKey="Phillips R" first="Richard" last="Phillips">Richard Phillips</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Kwame Nkrumah University of Science & Technology, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Kwame Nkrumah University of Science & Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff3">Komfo Anokye Teaching Hospital, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Nephrology</title><idno type="eISSN">1471-2369</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Anti-HIV Agents (adverse effects)</term><term>Anti-HIV Agents (therapeutic use)</term><term>Antiviral Agents</term><term>Causality</term><term>Comorbidity</term><term>Drug-Related Side Effects and Adverse Reactions (epidemiology)</term><term>Drug-Related Side Effects and Adverse Reactions (etiology)</term><term>Female</term><term>Ghana (epidemiology)</term><term>HIV Infections (drug therapy)</term><term>HIV Infections (epidemiology)</term><term>Humans</term><term>Kidney Diseases (chemically induced)</term><term>Kidney Diseases (epidemiology)</term><term>Male</term><term>Middle Aged</term><term>Prevalence</term><term>Proteinuria (chemically induced)</term><term>Proteinuria (epidemiology)</term><term>Risk Assessment</term><term>Tenofovir (adverse effects)</term><term>Tenofovir (therapeutic use)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Agents antiVIH (effets indésirables)</term><term>Agents antiVIH (usage thérapeutique)</term><term>Antiviraux</term><term>Causalité</term><term>Comorbidité</term><term>Effets secondaires indésirables des médicaments (épidémiologie)</term><term>Effets secondaires indésirables des médicaments (étiologie)</term><term>Femelle</term><term>Ghana (épidémiologie)</term><term>Humains</term><term>Infections à VIH (traitement médicamenteux)</term><term>Infections à VIH (épidémiologie)</term><term>Maladies du rein ()</term><term>Maladies du rein (épidémiologie)</term><term>Mâle</term><term>Protéinurie ()</term><term>Protéinurie (épidémiologie)</term><term>Prévalence</term><term>Ténofovir (effets indésirables)</term><term>Ténofovir (usage thérapeutique)</term><term>Évaluation des risques</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Anti-HIV Agents</term><term>Tenofovir</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-HIV Agents</term><term>Tenofovir</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Kidney Diseases</term><term>Proteinuria</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Agents antiVIH</term><term>Ténofovir</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Drug-Related Side Effects and Adverse Reactions</term><term>HIV Infections</term><term>Kidney Diseases</term><term>Proteinuria</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Drug-Related Side Effects and Adverse Reactions</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Agents antiVIH</term><term>Ténofovir</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Effets secondaires indésirables des médicaments</term><term>Ghana</term><term>Infections à VIH</term><term>Maladies du rein</term><term>Protéinurie</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Effets secondaires indésirables des médicaments</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Antiviral Agents</term><term>Causality</term><term>Comorbidity</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Prevalence</term><term>Risk Assessment</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Antiviraux</term><term>Causalité</term><term>Comorbidité</term><term>Femelle</term><term>Humains</term><term>Maladies du rein</term><term>Mâle</term><term>Protéinurie</term><term>Prévalence</term><term>Évaluation des risques</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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 HIV-associated renal dysfunction in Ghana and explore associations between proteinuria or TD and potential risk factors, including TDF use.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>In 330 patients, of whom 101 were taking TDF (median 20 months), the prevalence of CrCl < 60ml/min/1.73m<sup>2</sup>, 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 <italic>vs.</italic> 5.7 mg/mmol, <italic>p</italic> < 0.001), and urinary albuin:protein ratios significantly lower (0.24 <italic>vs.</italic> 0.58, <italic>p</italic> < 0.001).</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Szczech, La" uniqKey="Szczech L">LA Szczech</name></author><author><name sortKey="Gange, Sj" uniqKey="Gange S">SJ Gange</name></author><author><name sortKey="Van Der Horst, C" uniqKey="Van Der Horst C">C van der Horst</name></author><author><name sortKey="Bartlett, Ja" uniqKey="Bartlett J">JA Bartlett</name></author><author><name sortKey="Young, M" uniqKey="Young M">M Young</name></author><author><name sortKey="Cohen, Mh" uniqKey="Cohen M">MH Cohen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mocroft, A" uniqKey="Mocroft A">A Mocroft</name></author><author><name sortKey="Kirk, O" uniqKey="Kirk O">O Kirk</name></author><author><name sortKey="Reiss, P" uniqKey="Reiss 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uniqKey="Canetta P">PA Canetta</name></author><author><name sortKey="Herlitz, L" uniqKey="Herlitz L">L Herlitz</name></author><author><name sortKey="Mohan, S" uniqKey="Mohan S">S Mohan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mills, A" uniqKey="Mills A">A Mills</name></author><author><name sortKey="Crofoot, G" uniqKey="Crofoot G">G Crofoot</name></author><author><name sortKey="Mcdonald, C" uniqKey="Mcdonald C">C McDonald</name></author><author><name sortKey="Shalit, P" uniqKey="Shalit P">P Shalit</name></author><author><name sortKey="Flamm, Ja" uniqKey="Flamm J">JA Flamm</name></author><author><name sortKey="Gathe, J" uniqKey="Gathe J">J Gathe</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>Royaume-Uni</li></country></list><tree><noCountry><name sortKey="Chadwick, David R" sort="Chadwick, David R" uniqKey="Chadwick D" first="David R." last="Chadwick">David R. Chadwick</name><name sortKey="Kirk, Elaine S M" sort="Kirk, Elaine S M" uniqKey="Kirk E" first="Elaine S. M." last="Kirk">Elaine S. M. Kirk</name><name sortKey="Parris, Victoria" sort="Parris, Victoria" uniqKey="Parris V" first="Victoria" last="Parris">Victoria Parris</name></noCountry><country name="Ghana"><noRegion><name sortKey="Sarfo, Fred S" sort="Sarfo, Fred S" uniqKey="Sarfo F" first="Fred S." last="Sarfo">Fred S. Sarfo</name></noRegion><name sortKey="Bedu Addo, George" sort="Bedu Addo, George" uniqKey="Bedu Addo G" first="George" last="Bedu-Addo">George Bedu-Addo</name><name sortKey="Bedu Addo, George" sort="Bedu Addo, George" uniqKey="Bedu Addo G" first="George" last="Bedu-Addo">George Bedu-Addo</name><name sortKey="Owusu, Dorcas" sort="Owusu, Dorcas" uniqKey="Owusu D" first="Dorcas" last="Owusu">Dorcas Owusu</name><name sortKey="Phillips, Richard" sort="Phillips, Richard" uniqKey="Phillips R" first="Richard" last="Phillips">Richard Phillips</name><name sortKey="Phillips, Richard" sort="Phillips, Richard" uniqKey="Phillips R" first="Richard" last="Phillips">Richard Phillips</name><name sortKey="Sarfo, Fred S" sort="Sarfo, Fred S" uniqKey="Sarfo F" first="Fred S." last="Sarfo">Fred S. Sarfo</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Owusu, Ann Lorraine" sort="Owusu, Ann Lorraine" uniqKey="Owusu A" first="Ann Lorraine" last="Owusu">Ann Lorraine Owusu</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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