Abstract:
The use of tenofovir disoproxil fumarate (TDF) has been reported to be
a significant contributor to renal dysfunction. However, patients in Ethiopia may be different
than in other parts of the world, and findings from such studies may not apply in this setting.
Objective: This study aimed to assess TDF-associated renal dysfunction among adult
people living with HIV (PLHIV) at the University of Gondar Comprehensive Specialized
Hospital, Northwest Ethiopia.
Methods: This retrospective cohort study included adult PLHIV between January 2015 and
June 2019. The Chronic Kidney Disease Epidemiology (CKD-EPI) equation was used to
estimate glomerular filtration rate (eGFR). Renal dysfunction was defined as eGFR <60 mL/
min/1.73 m2. Data were entered into Epi Info™ 7 and analyzed by using SPSS® software
version 20. The Kaplan–Meier method was used to estimate the survival curves. Cox
proportional hazards models were used to identify predictors of renal dysfunction using
a 95% confidence interval and p-value ≤ 0.05 as a statistical significance.
Results: Out of 400 participants, 200 were TDF-based ART groups, and 200 were non-TDFbased ART groups. The incidence of renal dysfunction of TDF and the non-TDF group was
28.31 per 100 person-years (PYs) and 12.53 per 100 PYs, respectively. Adult PLHIV taking
TDF-based regimens were 1.70 (adjusted HR = 1.70; 95% CI = 1.02–2.82) times at higher
risk of renal dysfunction than non-TDF-based regimens. Age ≥55, diabetes mellitus, concurrent nephrotoxic drug use, and combined use of ritonavir-boosted protease inhibitors were
also associated significantly with renal dysfunction.
Conclusion: The incidence rate of renal dysfunction among TDF users is higher than nonTDF users. Exposure to TDF is a significant risk of renal dysfunction in adult PLHIV.
Clinicians should regularly monitor the renal function of adult PLHIV who are taking TDF.
Keywords: antiretroviral therapy, renal dysfunction, tenofovir disoproxil fumarate,
estimated glomerular filtration rate, northwest Ethiopia
