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and Hepatitis.com Coverage of the
61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2010)
October 29 - November 2, 2010, Boston, MA
Kidney Impairment on Tenofovir More Likely in HIV/HBV Coinfected Patients with Advanced Fibrosis
Tenofovir has potent activity against both HIV and hepatitis B virus (HBV), and treatment guidelines recommend that coinfected patients should include the drug as part of their antiretroviral regimen. Long-term use of tenofovir has been linked to kidney dysfunction in a small proportion of people with HIV alone, but this has not been extensively studied in HIV/HBV coinfected individuals.
In the present analysis, Anders Boyd from Hopital Saint-Antoine in Paris and colleagues looked at liver fibrosis as a risk factor for kidney dysfunction while on tenofovir. The study included 137 treatment-experienced patients (88% men, average age about 42 years) who started tenofovir and were followed for a median of about 33 months.
Liver fibrosis stage at baseline was estimated using a combination of blood biomarkers known as FibroMeter. Participants were classified as having absent-to-moderate fibrosis (equivalent to Metavir stage F0-F2) versus advanced fibrosis or cirrhosis (stage F3-F4).
Glomular filtration rate (GFR), an indicator of kidney function reflecting creatinine clearance, was estimated using the CKD-EPI equation at the start of treatment and averaged for every subsequent 6-month interval (expressed as mL/min/1.73m2). During follow-up, changes in GFR were stratified according to baseline fibrosis status.
Based on these findings, the researchers concluded, "HIV/HBV coinfected patients treated with tenofovir are at higher risk of [kidney] impairment when exhibiting high liver fibrosis level (> F3), thereby warranting a closer follow-up of GFR in this patient population."
affiliations: Infectious Diseases Unit, Hôpital Saint-Antoine,
INSERM U707, Paris, France; Hepatology, Hôtel-Dieu, Hospices Civils
de Lyon, Lyon, France.