Changes in glomerular filtration rate in HIV-infected adolescents on Tenofovir

Ncanywa, Zoleka Josephine
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Introduction: From 2019, South African antiretroviral therapy (ART) guidelines for first-line therapy in adolescents over 10 years of age, weighing more than 35 kilograms, contains tenofovir (TDF) which has been reported to impact on kidney function. Objectives: We assessed the change in estimated glomerular filtration rate (eGFR) over time in adolescents aged 10-19 years that were ever exposed to TDF at Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Academic Hospital, from 01 January 2010 to 31 December 2015. Results: Of the 346 adolescents receiving TDF-containing ART regimens during the study period, 117 (33.8%) met study inclusion criteria. Twenty (17.1%) developed sustained kidney dysfunction, contributing 246.0 person-years of follow-up; incidence of sustained kidney dysfunction was 8.1 per 100 person-years (95% confidence interval (CI):5.2, 12.6). Those with sustained kidney dysfunction on TDF-containing ART had significantly (P<0.001) lower baseline eGFR compared to adolescents with normal kidney function at last visit (108.56 mL/min/1.73m2 and 133.77 mL/min/1.73m2, respectively). One (0.9%) adolescent required referral to the paediatric nephrology clinic for evaluation of their kidney dysfunction. Conclusions: TDF appears safe in HIV-infected adolescents, however more studies are needed. Closer attention to monitoring of serum creatinine according to guideline recommendations is needed, particularly at TDF initiationand in older adolescents.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Paediatrics