Affordable Access

Access to the full text

Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China

  • Liu, Fang1
  • Xu, Aifang1
  • Zhao, Huaqing2
  • Yang, Zongxing3
  • Chen, Chen4
  • Ranieri, Brona4
  • Bao, Jianfeng5
  • Zheng, Guoxiang3
  • Wang, Miaochan1
  • Wang, Ying1
  • Xun, Yunhao5
  • 1 Medical Laboratory, Xixi Hospital of Hangzhou, Hangzhou
  • 2 Temple University School of Medicine, Department of Clinical Sciences, Philadelphia, PA
  • 3 Department of Infectious Diseases, Xixi Hospital of Hangzhou, Hangzhou
  • 4 Department of Neuroscience, Temple University, Philadelphia, PA
  • 5 Department of Integrated Chinese and Western Medicine, Xixi Hospital of Hangzhou, Hangzhou
Published Article
Therapeutics and Clinical Risk Management
Dove Medical Press Ltd.
Publication Date
Apr 17, 2020
DOI: 10.2147/TCRM.S243913
PMID: 32368069
PMCID: PMC7173951
PubMed Central


Purpose Estimated glomerular filtration rate (eGFR) decline in HIV-1-infected patients exposure to tenofovir disoproxil fumarate (TDF) has been widely assessed using linear models, but nonlinear assumption is not well validated. We constructed a retrospective cohort study to assess whether eGFR decline follows nonlinearity during antiviral therapy. Patients and Methods We examined 823 (299 of TDF users and 524 of non-TDF users) treatment-naïve HIV-1-infected participants (age ≥ 17 years, initial eGFR ≥ 90 mL/min/1.73m2). Estimated GFR trajectories were compared by one-linear and piecewise-linear mixed effects models, before and after propensity score matching, respectively. Whether the incidence of renal dysfunction (reduced renal function [RRF], eGFR < 90 mL/min/1.73 m2 and rapid kidney function decline [RKFD], eGFR > −3 mL/min/1.73 m2/year) follows nonlinearity was assessed by logistic regression. Results The median follow-up time of this study was 10 (interquartile range, 2–20) months, during which 178 (21.6%) experienced RRF, and 451 (54.8%) experienced RKFD. The slopes (mL/min/1.73 m2/year) of eGFR were −5.31 (95% CI: −6.57, −4.06) before 1.40 years, 4.83 (95% CI: 1.38, 8.28) from years 1.40 to 2.30 and −3.71 (95% CI: −5.97, −1.45) after 2.30 years among TDF users. Within years 1.40–2.30, each year of TDF exposure was associated with a 78% decreased risk of RKFD (95% CI: −91%, −49%). In comparison, eGFR increased slightly at the initiation of antiviral therapy, declined after 2.15 years (−4.96; 95% CI: −5.76, −4.17) among non-TDF users. Such a progression nonlinear trajectory was missed on the assumption of one-linearity, whether in TDF or non-TDF users. Conclusion Over the piecewise mixed-effects analyses with the advantage of revealing the true nature of the exposure outcome relationships, an interesting reverse S-shaped relationship was observed. A routine screen based on nonlinearity could be more helpful for patient management.

Report this publication


Seen <100 times