CKD Prevalence in HIV Patients on TDF: A Global Perspective

The article presents a systematic review and meta-analysis on the CKD prevalence HIV TDF among people living with HIV (PLWHIV) on Tenofovir Disoproxil Fumarate (TDF) based regimens. The study found a pooled prevalence of CKD to be 7% globally. Significant associations are found between CKD and factors like low CD4 count and female gender. The review highlights the need for regular renal function monitoring and early CKD identification to prevent complications.

Key Insights

• CKD Prevalence: The global pooled prevalence of CKD among PLWHIV on TDF regimens is 7%. This indicates a significant health concern linked to CKD prevalence HIV TDF.
• Risk Factors: Low CD4 count (<200 copies/ml) and female gender are significant risk factors for CKD in this population.
• Regional Variations: CKD prevalence varies significantly across regions. Higher rates are observed in Sub-Saharan Africa.
• TDF Nephrotoxicity: TDF causes renal toxicity, likely by inhibiting mitochondrial DNA polymerase gamma, though the exact mechanism remains unclear.

Background Context

Healthcare providers widely use Tenofovir Disoproxil Fumarate (TDF) as an antiretroviral drug for HIV treatment. It is known for its efficacy and safety profile. However, it has been linked to renal toxicity and CKD, especially in populations with pre-existing renal conditions or other risk factors. The World Health Organization (WHO) and other health authorities recommend monitoring renal function in patients on TDF-based regimens. TDF use is common globally, but its nephrotoxic effects require careful management and monitoring. This is particularly important in resource-limited settings where baseline renal function assessments may not be routine.

Implications

The purpose of this content is to highlight the significant implications of this study’s findings for health economics and outcomes research:

• Healthcare Policy: The high prevalence of CKD among PLWHIV on TDF regimens underscores the need for healthcare policymakers to develop strategies for early CKD detection and management.
• Resource Allocation: In low-income countries, prioritising renal function monitoring for those on TDF could help mitigate CKD risk.
• Alternative Treatments: The study supports considering alternative antiretroviral drugs like Tenofovir Alafenamide (TAF). TAF has better renal safety profiles compared to TDF.
• Economic Impact: Long-term CKD management can be costly. Preventing its onset through careful drug selection and monitoring could reduce healthcare expenditures. For more details, refer to the original study.

By focusing on the CKD prevalence HIV TDF, this review emphasises the importance of monitoring and proactive measures in the care of PLWHIV.