Coinfection

EASL 2011: Kidney Function in HIV/HBV Coinfected People on Tenofovir

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Impaired kidney function among people with HIV, HBV, and HIV/HBV coinfection taking tenofovir mainly occurred in those with pre-existing risk factors, researchers reported at EASL 2011.

Tenofovir (Viread, also in the Truvada and Atripla coformulations) is highly effective in treating both hepatitis B virus (HBV) and HIV, but it can cause kidney impairment in susceptible individuals.

As reported in a poster at the European Association for the Study of the Liver's International Liver Congress (EASL 2011) this month in Berlin, French researchers compared changes in glomerular filtration rate (GFR) -- a laboratory measure of kidney function -- in HIV monoinfected, HBV monoinfected, and HIV/HBV coinfected patients treated with tenofovir.

This retrospective analysis included 194 HIV positive patients receiving first-line antiretroviral therapy, 50 people with hepatitis B alone, and 85 with HIV/HBV coinfection. All participants had used tenofovir for more than 1 year. As a group, the coinfected patients had taken tenofovir significantly longer than those with HIV or HBV alone (3.9 years vs 2.4 years, respectively).

More than 70% of study participants were men and about one-third were of African descent (a group at higher risk for kidney diseases). People with HBV were on average older, less likely to be African, and had lower baseline GFR. Patients with decompensated cirrhosis, liver cancer, pre-existing kidney insufficiency, and liver transplant recipients were excluded.

Results

  • Over a median follow-up period of 2.7 years, the median GFR decrease according to the MDRD equation was -4.9 mL/min.
  • In a multivariate analysis, significant predictors of GFR decrease in the study population as a whole were:
  • Older age (P = 0.0002);
  • African origin (P < 0.0001);
  • Poorer GFR at baseline (P < 0.0001);
  • Longer duration of tenofovir use (P = 0.02).
  • In contrast, arterial hypertension (high blood pressure), diabetes, and type of infection (HIV, HBV, or HIV/HBV) were not independent risk factors.
  • Among HIV monoinfected and HIV/HBV coinfected participants, the following factors remained significantly associated with GFR decline:
  • Older age (P < 0.0001);
  • African origin (P = 0.0004);
  • Poorer baseline GFR (P < 0.0001);
  • Longer tenofovir duration (P = 0.007).
  • Other variables, including HIV transmission risk factor, CDC HIV/AIDS stage, CD4 T-cell count, and HIV viral load were not significant risk factors.
  • Among people with HBV alone or HIV/HBV coinfection, significant predictors were:
  • Older age (P = 0.03);
  • African origin (P = 0.004);
  • Poorer baseline GFR (P < 0.0001);
  • HBV viral load > 2000 IU/mL (P = 0.04).
  • Other variables including HBV transmission risk factor and liver fibrosis stage were not independent predictors.

 

Based on these findings, the researchers concluded, "GFR decline under tenofovir therapy appears mainly associated with older age, non-African origin, higher baseline GFR and longer tenofovir duration. The effect of baseline HBV DNA deserves further study."

Investigator affiliations: Hospices Civils de Lyon, Lyon, France; INSERM U871, Université Lyon 1, Lyon, France.

4/19/11

Reference
L Cotte, M-A Le Pogam, J-B Okon, et al. Evolution of glomerular filtration rate in HIV-infected, HIV-HBV coinfected and HBV-infected patients receiving tenofovir. 46th Annual Meeting of the European Association for the Study of the Liver (EASL 2011). Berlin. March 30-April 3. Abstract 587.