Renal impairment in a large-scale HIV preexposure prophylaxis implementation cohort

被引:8
作者
Drak, Douglas [1 ,2 ]
Mcmanus, Hamish [3 ]
Vickers, Tobias [3 ]
Heron, Jack E. [4 ]
Vaccher, Stefanie [3 ]
Zablotska, Iryna [5 ,6 ,7 ]
Guy, Rebecca [3 ]
Bavinton, Benjamin [3 ]
Jin, Fengyi [3 ]
Grulich, Andrew E. [3 ]
Bloch, Mark [8 ]
O'Connor, Catherine C. [3 ]
Gracey, David M. [1 ,4 ]
机构
[1] Univ Sydney, Cent Clin Sch, Camperdown, NSW 2050, Australia
[2] Wagga Wagga Base Hosp, Wagga Wagga, NSW, Australia
[3] UNSW Sydney, Kirby Inst, Sydney, NSW, Australia
[4] Royal Prince Alfred Hosp, Dept Renal Med, Camperdown, NSW, Australia
[5] Univ Sydney, Westmead Clin Sch, Fac Med & Hlth, Westmead, NSW, Australia
[6] Univ Sydney, Marie Bashir Inst Infect Dis & Biosecur, Westmead, NSW, Australia
[7] Western Sydney Local Hlth Dist, Western Sydney Sexual Hlth Ctr, Parramatta, Australia
[8] Holdsworth House Med Practice, Darlinghurst, NSW, Australia
关键词
HIV; kidney disease; preexposure prophylaxis; risk factors; tenofovir; TENOFOVIR DISOPROXIL FUMARATE; TUBULAR DYSFUNCTION; BANGKOK TENOFOVIR; KIDNEY-FUNCTION; MEN; DECLINE; RISK; FUMARATE/EMTRICITABINE; REVERSIBILITY; ADHERENCE;
D O I
10.1097/QAD.0000000000003035
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: HIV preexposure prophylaxis (PrEP) with fixed-dose tenofovir disoproxil fumarate (TDF) and emtricitabine has been associated with low rates of renal impairment in clinical trials. Large-scale PrEP implementation may result in higher rates, as the prevalence of associated risk factors may be higher than in trial populations. Methods: A posthoc analysis of EPIC-NSW, a large Australian multicentre PrEP implementation trial for patients at high risk of HIV infection. Participants were eligible for inclusion if they commenced PrEP between 1 March 2016 and 30 April 2018, and had renal function assessed at baseline and at least once more before the censor date. The primary outcome was new-onset renal impairment, defined as an estimated glomerular filtration rate (eGFR) Results: A total of 6808 participants were eligible for inclusion. Almost all were male (99%), with a median age of 35 years [interquartile range (IQR): 28-44]. Approximately one-quarter (26%) had a baseline eGFR <90 ml/min per 1.73 m(2). Over a median follow-up period of 1.2 years (IQR: 0.6-1.7), the rate of renal impairment was 5.8 episodes per 1000 person-years [95% confidence interval (CI): 4.0-7.8]. In multivariable Cox regression, there was a higher risk of renal impairment in participants aged >= 50 years [hazard ratio (HR) 14.7, 95% CI: 5.0-43.3, P < 0.001] and those with an eGFR <90 ml/min per 1.73 m(2) (HR 28.9, 95% CI: 6.9-121.9) at baseline. Conclusion: In a large-scale implementation study, TDF-containing PrEP was associated with a low risk of renal impairment overall, whereas older patients and those with preexisting renal dysfunction were at substantially increased risk.
引用
收藏
页码:2319 / 2326
页数:8
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