A consensus statement on the renal monitoring of Australian patients receiving tenofovir based antiviral therapy for HIV/HBV infection

Holt, Stephen G., Gracey, David M., Levy, Miriam T., Mudge, David W., Irish, Ashley B., Walker, Rowan G., Baer, Richard, Sevastos, Jacob, Abbas, Riaz and Boyd, Mark A. (2014) A consensus statement on the renal monitoring of Australian patients receiving tenofovir based antiviral therapy for HIV/HBV infection. AIDS Research and Therapy, 11 1: 1-10. doi:10.1186/1742-6405-11-35


Author Holt, Stephen G.
Gracey, David M.
Levy, Miriam T.
Mudge, David W.
Irish, Ashley B.
Walker, Rowan G.
Baer, Richard
Sevastos, Jacob
Abbas, Riaz
Boyd, Mark A.
Title A consensus statement on the renal monitoring of Australian patients receiving tenofovir based antiviral therapy for HIV/HBV infection
Journal name AIDS Research and Therapy   Check publisher's open access policy
ISSN 1742-6405
Publication date 2014-11-10
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/1742-6405-11-35
Open Access Status DOI
Volume 11
Issue 1
Start page 1
End page 10
Total pages 10
Place of publication London United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus (HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate (TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine and dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment and ongoing monitoring of renal function is an important part of routine management of patients with HIV.

Given the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring could be performed in Australian patients on ART regimens, especially those involving TDF. A group of nephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical and reasonable renal management strategies for patients particularly those on TDF-based combination regimens (in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group considered which investigations should be performed as part of routine practice, their frequency, and when specialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with plasma phosphate and an assessment of urinary protein (rather than albumin) and glucose.

Here we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g. cobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this value used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly thereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment should be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing protocol may be logical.
Keyword HIV
Hepatitis B
Tenofovir
Renal failure
Fanconi syndrome
Monitoring
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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