Original Research
Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania
Submitted: 17 July 2024 | Published: 31 January 2025
About the author(s)
Sabina F. Mugusi, Department of Clinical Pharmacology, School of Biomedical Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania; and Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United StatesGrace A. Shayo, Department of Internal Medicine, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Philip G. Sasi, Department of Clinical Pharmacology, School of Biomedical Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Lulu S. Fundikira, Department of Radiology and Imaging, School of Diagnostic Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Eric A. Aris, Management and Development for Health, Dar es Salaam, Tanzania, United Republic of
Christopher R. Sudfeld, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States
Ferdinand M. Mugusi, Department of Internal Medicine, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Abstract
Background: Kidney disease is a growing non-AIDS-related comorbidity among people living with HIV (PLWH). Tenofovir disoproxil fumarate (TDF) can result in proximal tubulopathy and acute tubular injury, whereas atazanavir/ritonavir (ATV/r) can cause interstitial nephritis and renal stones, both of which can lead to chronic kidney disease.
Objectives: To examine the relationship between second-line combination antiretroviral therapy (ART) and the risk of kidney disease and morphological changes among PLWH in Dar es Salaam, Tanzania.
Method: A cross-sectional study of adult PLWH receiving TDF-based second-line ART. Socio-demographic and clinical data were gathered, and laboratory tests were conducted to determine the estimated glomerular filtration rate (eGFR). Ultrasonography was performed to visualise the kidneys.
Results: A total of 323 patients were enrolled (67.8% women), with a median age of 44 (interquartile range [IQR]: 39–51) years. Patients were on second-line ART for a median of 49 [IQR: 25–73] months, and 60% received ATV/r. Low eGFR (< 90 mL/min per 1.73 m2) was found in 22% of patients, proportionately higher among patients on ATV/r compared to those on a lopinavir/ritonavir (LPV/r) (P < 0.05). Nearly one-third (32.2%) of patients had a triad of renal calcinosis, renal calculi, and nephritis on ultrasonography. Patients using ATV/r had significantly smaller kidney volumes and greater proportions of renal calculi and nephritis compared to those on LPV/r (P < 0.05).
Conclusion: Adults on second-line ART containing TDF were found to have a high prevalence of renal kidney disease in the Tanzanian context. Predictors of kidney disease were older age, proteinuria, and ATV/r-based regimen as compared to LPV/r.
Keywords
Sustainable Development Goal
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