Junko TanumaAwachana JiamsakulAbhimanyu MakaneAnchalee AvihingsanonOon Tek NgSasisopin KiertiburanakulRomanee ChaiwarithNagalingeswaran KumarasamyKinh Van NguyenThuy Thanh PhamMan Po LeeRossana DitangcoTuti Parwati MeratiJun Yong ChoiWing Wai WongAdeeba KamarulzamanEvy YunihastutiBenedict Lh SimWinai RatanasuwanPacharee KantipongFujie ZhangMahiran MustafaVonthanak SaphonnSanjay PujariAnnette H. SohnC. V. MeanV. SaphonnK. VohithF. J. ZhangH. X. ZhaoN. HanP. C.K. LiW. LamY. T. ChanK. H. WongS. SaghayamC. EzhilarasiK. JoshiD. N. WirawanF. YulianaD. ImranA. WidhaniS. OkaT. NishijimaS. NaJ. M. KimY. M. GaniR. DavidS. F.Syed OmarS. PonnampalavanarI. AzwaN. HudaL. Y. OngE. UyR. BantiqueW. W. KuP. C. WuP. L. LimL. S. LeeP. S. OhnmarP. PhanuphakK. RuxrungthamP. ChusutS. SirivichayakulS. SungkanuparphL. ChumlaN. SanmeemaR. ChaiwarithT. SirisanthanaW. KotarathititumJ. PraparattanapanP. KantipongP. KambuaR. SriondeeV. H. BuiT. T. CaoD. D. CuongH. L. HaN. DurierB. PetersenT. SingtorojD. A. CooperM. G. LawD. C. BoettigerNational Center for Global Health and MedicineUniversity of New South Wales (UNSW) AustraliaInstitute of Infectious DiseasesChulalongkorn UniversityTan Tock Seng HospitalMahidol UniversityChiang Mai UniversityVHS Medical Centre IndiaNational Hospital of Tropical DiseasesBach Mai HospitalQueen Elizabeth Hospital Hong KongGokilaUniversitas UdayanaYonsei UniversityVeterans General Hospital-TaipeiUniversity of Malaya Medical CentreUniversity of Indonesia, RSUPN Dr. Cipto MangunkusumoHospital Sungai BulohChiangrai Prachanukroh HospitalBeijing Ditan HospitalHospital Raja Perempuan Zainab IIUniversity of Health SciencesamfAR - The Foundation for AIDS ResearchNational Center for HIV/AIDSIntegrated Treatment CentreThe HIV Netherlands Australia Thailand Research CollaborationNational Hospital for Tropical Diseases2018-12-112019-03-142018-12-112019-03-142016-08-01PLoS ONE. Vol.11, No.8 (2016)193262032-s2.0-84990036805https://repository.li.mahidol.ac.th/handle/123456789/43243© 2016 Tanuma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: In resource-limited settings, routine monitoring of renal function during antiretroviral therapy (ART) has not been recommended. However, concerns for tenofovir disoproxil fumarate (TDF)-related nephrotoxicity persist with increased use. Methods: We investigated serum creatinine (S-Cr) monitoring rates before and during ART and the incidence and prevalence of renal dysfunction after starting TDF by using data from a regional cohort of HIV-infected individuals in the Asia-Pacific. Time to renal dysfunction was defined as time from TDF initiation to the decline in estimated glomerular filtration rate (eGFR) to <60 ml/min/1.73m2 with >30% reduction from baseline using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation or the decision to stop TDF for reported TDF-nephrotoxicity. Predictors of S-Cr monitoring rates were assessed by Poisson regression and risk factors for developing renal dysfunction were assessed by Cox regression. Results: Among 2,425 patients who received TDF, S-Cr monitoring rates increased from 1.01 to 1.84 per person per year after starting TDF (incidence rate ratio 1.68, 95%CI 1.62-1.74, p <0.001). Renal dysfunction on TDF occurred in 103 patients over 5,368 person-years of TDF use (4.2%; incidence 1.75 per 100 person-years). Risk factors for developing renal dysfunction included older age (>50 vs. ≤30, hazard ratio [HR] 5.39, 95%CI 2.52-11.50, p <0.001; and using PI-based regimen (HR 1.93, 95%CI 1.22-3.07, p = 0.005). Having an eGFR prior to TDF (pre-TDF eGFR) of ≥60 ml/min/1.73m2 showed a protective effect (HR 0.38, 95%CI, 0.17-0.85, p = 0.018). Conclusions: Renal dysfunction on commencing TDF use was not common, however, older age, lower baseline eGFR and PI-based ART were associated with higher risk of renal dysfunction during TDF use in adult HIV-infected individuals in the Asia-Pacific region.Mahidol UniversityAgricultural and Biological SciencesBiochemistry, Genetics and Molecular BiologyArticleSCOPUS10.1371/journal.pone.0161562