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Clinician compliance with laboratory monitoring and prescribing guidelines in HIV-1-infected patients receiving tenofovir

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  • معلومة اضافية
    • بيانات النشر:
      South African Medical Association
    • الموضوع:
      2016
    • Collection:
      South African Medical Journal (SAMJ)
    • الموضوع:
    • الموضوع:
      2010-2012; 13168 patients, 37% male, median age 35 years, mostly Black Africans
    • نبذة مختصرة :
      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 <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 <50 mL/min. While on tenofovir, 525 patients had at least one CrCl of <50 mL/min. Of 382 patients with ≥3 months’ follow-up after a CrCl <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 <50 mL/min. Further research is needed to determine how best to monitor renal function with tenofovir in resource-limited settings.
    • File Description:
      application/pdf
    • Relation:
      http://samj.org.za/index.php/samj/article/view/10153/7250; http://samj.org.za/index.php/samj/article/view/10153
    • الرقم المعرف:
      10.7196/SAMJ.2016.v106i4.10153
    • الدخول الالكتروني :
      http://samj.org.za/index.php/samj/article/view/10153
      https://doi.org/10.7196/SAMJ.2016.v106i4.10153
    • Rights:
      Copyright of published material remains in the Authors’ name. This allows authors to use their work for their own non-commercial purposes without seeking permission from the Publisher, subject to properly acknowledging the Journal as the original place of publication. Authors are free to copy, print and distribute their articles, in full or in part, for teaching activities, and to deposit or include their work in their own personal or institutional database or on-line website. Authors are requested to inform the Journal/Publishers of their desire/intention to include their work in a thesis or dissertation or to republish their work in any derivative form (but not for commercial use). Material submitted for publication in the SAMJ is accepted provided it has not been published or submitted for publication elsewhere. Please inform the editorial team if the main findings of your paper have been presented at a conference and published in abstract form, to avoid copyright infringement.
    • الرقم المعرف:
      edsbas.6F9C6113