# Kidney disease among adults on tenofovir-based second-line antiretroviral therapy in Dar es Salaam, Tanzania

## TL;DR

This study found that adults on tenofovir-based HIV treatment in Tanzania have a high risk of kidney disease, especially those on atazanavir/ritonavir.

## Contribution

The study identifies ATV/r as a significant predictor of kidney disease in TDF-based second-line ART regimens in a Tanzanian population.

## Key findings

- 22% of patients had low eGFR, with higher rates among those on ATV/r.
- 32.2% of patients showed a triad of renal calcinosis, calculi, and nephritis.
- ATV/r users had smaller kidney volumes and more renal calculi and nephritis compared to LPV/r users.

## Abstract

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.

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.

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.

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).

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.