Abstract

Dr. V. Ramachandran, Dr. A. Kalanad, *Dr. S. Mathew

ABSTRACT

Tenofovir based ART regimen is currently used as the first line anti retroviral therapy by NACO in India. As a part of national strategy, ?Paving the way for an AIDS free India? NACO recommends initiation of ART irrespective of stage or CD4 count. The major side effects of TDF are renal toxicity and decrease in bone marrow density. A prospective Cohort Study was conducted in 202 patients, started on Tenofovir based ART to find out the incidence and predictors of nephrotoxicity. S.Creatinine 1.5 times the basal value, increase in serum creatinine more than or equal to 0.3mg/dl above the basal value, hypophosphatemia, hypouricemia, proteinuria, glycosuria, hypokalaemia & hypocalcaemia were the parameters checked. Gender, age, stage of HIV infection, CD4 count, body mass index, co morbidities (diabetes, hypertension, opportunistic infections), concomitant nephrotoxic medications, & serum creatinine level before starting treatment were the predictors of nephrotoxicity studied. Nephrotoxicity of Tenofovir was 13.9%.Average time to develop nephrotoxicity was 118 days. Average decline in creatinine clearance during renal dysfunction was 21.4 ml/min & almost all cases were asymptomatic. Nephrotoxicity was detected in the form of mild derangement of RFT and proteinuria on regular follow up. Advanced clinical stage and low CD4 count had significant association with nephrotoxicity. Single most important predictor of Tenofovir induced nephrotoxicity was CD4 count. Small sample size, short period of follow up and a smaller number of cases in the subgroups of co-morbidities were the major limitations.