Association of tenofovir disoproxil fumarate exposure with chronic kidney disease and osteoporotic fracture in US veterans with HIV

Abstract

Background

Tenofovir disoproxil fumarate (TDF)-based regimens have been associated with impaired kidney function and loss of bone mineral density among patients living with HIV (PLWH). We assess the association between TDF exposure and the odds of chronic kidney disease (CKD) and osteoporotic fracture in HIV patients.

Methods

Demographics, administrative claims, and pharmacy dispensation were extracted from the Veterans Affairs Informatics and Computing Infrastructure (VINCI). Patients were categorized based on TDF utilization. Incidence rates for patients exposed and unexposed to TDF were calculated per 1000 patient-years (PYs). Logistic regression was used to calculate the odds of outcome after adjusting for baseline and clinical characteristics.

Results

The sample included 4,630 PLWH who were currently exposed to TDF and 1,181 who were never exposed to TDF for the CKD analyses. For fracture analyses, the sample included 6,883 PLWH who were currently exposed to TDF and 1,951 who were never exposed to TDF. In adjusted models, current TDF exposure was associated with increased odds of CKD compared to never having been exposed (OR: 1.48, 95% CI: 1.18–1.85). Odds of fracture were 2.32 times higher for patients who were currently on a TDF regimen (OR: 2.32, 95% CI: 1.58–3.42) compared to those who had never been exposed to TDF in adjusted models.

Conclusions

In a large cohort of US veterans with HIV, current exposure to TDF was associated with a 48% higher odds of CKD and a greater than two-fold increase in the odds of osteoporotic fracture.

Keywords:

• HIV
• veteran affairs informatics and computing infrastructure
• tenofovir disoproxil fumarate (TDF)
• chronic kidney disease (CKD)
• osteoporotic fractures

Transparency

Declaration of funding

This study was supported by a research grant from Gilead Sciences.

Declaration of financial/other relationships

This paper represents original research conducted using data from the Department of Veterans Affairs. This material is the result of work supported with resources and the use of facilities at the Dorn Research Institute, Columbia VA Health Care System, Columbia, South Carolina. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

SS declares receiving research grants from Boehringer Ingelheim, Portola Pharmaceuticals, and United Therapeutics, all for projects unrelated to this research. The remaining authors and peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

The authors of the paper had the following roles: involved in the conception and design: SS, JM, JH, LH, AB, SM; analysis: SS, JM, JH; interpretation of the data: SS, JM, JH, LH, AB, SM, TC; drafting of the paper: SS, JM, JH, LH, AB, SM, TC; revising it critically for intellectual content: SS, JM, JH, LH, AB, SM, TC; final approval of the version to be published: SS, JM, JH, LH, AB, SM, TC; and that all authors agree to be accountable for all aspects of the work: SS, JM, JH, LH, AB, SM, TC.

Acknowledgements

No assistance in the preparation of this article is to be declared.