McLeod Regional Medical Center, 161463, Florence, South Carolina, United States ; firstname.lastname@example.org.
Grady Health System, Pharmacy and Drug Information , 80 Jesse Hill Jr Drive SE , Atlanta, Georgia, United States , 30303 ; email@example.com.
Grady Health System, Department of Pharmacy and Drug Information , 80 Jesse Hill Jr Dr SE , Altlanta, Georgia, United States , 30303 ; firstname.lastname@example.org.
Grady Health System, 1365, Infectious Diseases Program, Atlanta, Georgia, United States ; email@example.com.
Emory University School of Medicine, 12239, Medicine Division of General Medicine and Geriatrics, Atlanta, Georgia, United States ; firstname.lastname@example.org.
3Emory University School of Public Health, Biostatistics and Bioinformatics, Atlanta, Georgia, United States ; email@example.com.
Emory University School of Medicine, 12239, Medicine Division of Infectious Diseases, Atlanta, Georgia, United States ; firstname.lastname@example.org.
Background Ledipasvir/sofosbuvir (LDV/SOF), an antiviral treatment for hepatitis C virus (HCV), and tenofovir disoproxil fumarate (TDF), an antiretroviral for treating human immunodeficiency virus (HIV), may be co-administered in patients co-infected with these viruses. A drug interaction between LDV and TDF could increase TDF-associated nephrotoxicity rates; however, there is minimal clinical evidence describing acute kidney injury (AKI) rates in this population. Setting This study was conducted at a Ryan White-funded facility in Atlanta, Georgia, that cares for over 5,000 patients with AIDS. Methods This retrospective cohort used chart review to assess occurrence of and risk factors for AKI in HIV/HCV co-infected patients receiving LDV/SOF and antiretroviral therapy (ART). AKI rates were compared between TDF-containing and non-TDF-containing ART groups according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Additional evaluated risk factors for AKI included chronic kidney disease and use of boosted protease inhibitor-based ART. Results In the 117 included patients, the overall incidence of AKI was 27.3%. AKI occurred more frequently in the non-TDF group (13/86, 15.1% vs. 19/31, 61.3%, P<0.001). All AKI was KDIGO stage 1. From multivariable logistic regression, the only independent predictor of AKI was treatment with non-TDF relative to TDF (adjusted odds ratio 6.51, 95% CI 2.34-18.10, P<0.001). Conclusions In this real-world cohort of HIV/HCV co-infected patients, KDIGO-defined AKI was common but occurred less frequently in patients receiving TDF-based ART. Our study suggests that patients with normal baseline renal function can be safely treated with TDF and LDV/SOF without significant nephrotoxicity if renal function is closely monitored.