Evidence map›Paper›PMID 36827395›Full record

Observational studyPloS one2023

Renal impairment associated with tenofovir disoproxil fumarate for antiretroviral therapy and HIV pre-exposure prophylaxis: An observational cohort study.

Jack E Heron, Hamish McManus, Tobias Vickers, Kathleen Ryan, Edwina Wright, Allison Carter, Mark Stoove, Jason Asselin, Andrew Grulich, Basil Donovan and 9 more

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.6field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 3 citations in OpenAlex.

  1. Observational
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 6 institutions in 1 country.

Jack E HeronDepartment of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.ORCID 0000-0002-6641-4754
Hamish McManusThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
Tobias VickersThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
Kathleen RyanDepartment of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia.
Edwina WrightDepartment of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia.
Allison CarterThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
Mark StooveBurnet Institute, Melbourne, Victoria, Australia.
Jason AsselinBurnet Institute, Melbourne, Victoria, Australia.ORCID 0000-0003-0823-4816
Andrew GrulichThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
Basil DonovanThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.ORCID 0000-0001-8851-4126
Rebecca GuyThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
Rick VarmaThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
Marcus ChenMelbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
Nathan RyderThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.ORCID 0000-0002-2050-0155
David A LewisWestern Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia.
David J TempletonFaculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
Catherine C O'ConnorThe Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia.
David M GraceyDepartment of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
ACCESS Collaboration
UNSW Sydney · AUBurnet Institute · AUThe University of Sydney · AUMelbourne Sexual Health Centre · AURoyal Prince Alfred Hospital · AUSydney Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTenofovir disoproxil fumarate (TDF) is associated with adverse renal outcomes when prescribed for HIV infection. There are few data concerning real-world renal outcomes amongst patients prescribed TDF for pre-exposure prophylaxis (PrEP). METHODS AND

findingsData were extracted from 52 sexual health clinics across Australia from 2009-2019. All patients prescribed TDF-containing antiretroviral therapy and PrEP were included. Rates of renal impairment (a fall in eGFR to <60 ml/min/1·73m2) were calculated for people living with HIV (PLWHIV) prescribed TDF and HIV negative PrEP-users. Risk factors were assessed using Cox-proportional hazards models. Sensitivity analysis of risk using 1:1 propensity-score matching to adjust for potential imbalance in HIV and PrEP cohorts was conducted. 5,973 patients on PrEP and 1,973 PLWHIV were included. There were 39 (0.7%) instances of renal impairment in the PrEP group and 81 (4.1%) in the PLWHIV cohort (hazard ratio [HR]:0.35 95% confidence interval [CI]: 0.22-0.56). Rates of renal impairment were 4.01/1000 person-years (95%CI:2.93-5.48) in the PrEP cohort and 16.18/1000 person-years (95%CI:13.01-20.11) in the PLWHIV cohort (p<0.001). Predictors of renal impairment were: older age (40-49 years (HR:5.09 95%CI: 2.12-12.17) and 50-82 years (HR:13.69 95%CI: 5.92-31.67) (compared with 30-39 years) and baseline eGFR<90ml/min (HR:61.19 95%CI: 19.27-194.30). After adjusting for age and baseline eGFR the rate of renal impairment remained lower in the PrEP cohort (aHR:0.62 95%CI: 0.40-0.94, p = 0.023). In propensity-matched analysis using 1,622 patients per cohort the risk of renal impairment remained higher in the PLWHIV cohort (log-rank p = 0.001).

conclusionPatients prescribed TDF-based PrEP had lower rates of renal impairment than patients prescribed TDF for HIV infection. In propensity analysis, after matching for some risk factors, rates of renal impairment remained higher amongst patients with HIV.

Indexed as

Acquired Immunodeficiency SyndromeAnti-HIV AgentsHIV InfectionsPre-Exposure ProphylaxisRenal InsufficiencyCohort StudiesEmtricitabineHumansTenofovirAnti-HIV AgentsEmtricitabineTenofovir

Identifiers

PMID36827395
PMCPMC9955644
OpenAlexW4321770339

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.