Clinician Compliance with Laboratory Monitoring and Prescribing Guidelines in HIV-1-Infected Patients Receiving Tenofovir

BACKGROUND:Tenofovir is part of the preferred first-line regimen for HIV-infected patients in South Africa (SA); but is associated with kidney toxicity. SA antiretroviral therapy (ART) guidelines recommend creatinine monitoring at baseline (ART start) and at 3; 6 and 12 months; and substituting tenofovir with zidovudine; stavudine or abacavir should creatinine clearance (CrCl) decrease to etlt;50 mL/min. OBJECTIVE:To assess clinician compliance with tenofovir monitoring and prescribing guidelines.METHODS:We described the proportion of adult patients on tenofovir-based first-line ART who were screened for baseline renal impairment; were monitored according to the SA antiretroviral treatment guidelines; and were switched from tenofovir if renal function declined.RESULTS:We included 13 168 patients who started ART from 2010 to 2012. Creatinine concentrations were recorded in 11 712 (88.9%) patients on tenofovir at baseline; 9 135/11 657 (78.4%) at 3 months; 5 426/10 554 (51.4%) at 6 months; and 5 949/ 8 421 (70.6%) at 12 months. At baseline; 227 (1.9%) started tenofovir despite a CrCl etlt;50 mL/min. While on tenofovir; 525 patients had at least one CrCl of etlt;50 mL/min. Of 382 patients with =3 months' follow-up after a CrCl etlt;50 mL/min; 114 (29.8%) stopped tenofovir within 3 months. Clinicians were more likely to stop tenofovir in patients with lower CrCl and CD4 count. Of 226 patients who continued to receive tenofovir and had further CrCls available; 156 (69.0%) had a CrCl =50 mL/min at their next visit.CONCLUSIONS:Creatinine monitoring is feasible where access to laboratory services is good. Kidney function recovered in most patients who continued to receive tenofovir despite a CrCl etlt;50 mL/min. Further research is needed to determine how best to monitor renal function with tenofovir in resource-limited settings

Plasmodium falciparum-induced kidney and liver dysfunction in malaria patients in Freetown; Sierra Leone

This study was undertaken to investigate the effect of Plasmodium falciparum infection on kidney and liver function parameters in malaria patients in Freetown; Sierra Leone. Blood samples taken from 64 malaria patients and 64 non-malaria volunteers at Abanita and Blue Shield Hospitals; Freetown Sierra Leone between January to April; 2009 were examined. Changes in serum biochemical parameters were analysed using normal range values as baseline. Serum bilirubin; alkaline phosphatase (ALP); alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations were significantly elevated in falciparum malaria patients compared to their non-malaria counterparts which is an indication of defective liver function. Most of patients with falciparum malaria also have significantly high serum concentrations of urea; creatinine; sodium and potassium showing alteration in kidney function. This study suggests that malaria parasites could be responsible for derangement of kidney and liver functions in patients and could therefore contribute to organ damage in affected individuals if not treated

Two-hour urinary phenolsulphonphthalein excretion test - a simple test of glomerular function in renal failure

Urinary phenolsulphonphthalein excretion and endogenous creatinine clearance tests were performed in 17 Nigerian patients with established renal failure (serum creatinine 2mg). Fourteen subjects with normal renal function served as controls. Higher and statistically significant amount of the dye was excreted by the control subjects at 15; 30; 60 and 120 minutes post injection. There is a good correlation between the two tests in the patients but not explicable so in the controls. The simplicity of this method and its predictability of glomerular filtration rate without the need for a 24 hour urine collection recommends it for use in the routine management of renal patients in Nigeria