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 <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 CONLUSIONS: 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
Main Authors: | , , , , , , |
---|---|
Format: | Digital revista |
Language: | English |
Published: |
South African Medical Association
2016
|
Online Access: | http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000400024 |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
id |
oai:scielo:S0256-95742016000400024 |
---|---|
record_format |
ojs |
spelling |
oai:scielo:S0256-957420160004000242016-04-20Clinician compliance with laboratory monitoring and prescribing guidelines in HIV 1-infected patients receiving tenofovirde Waal,RCohen,KFox,M PStinson,KMaartens,GBoulle,ADavies,M-ABACKGROUND: 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 CONLUSIONS: 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 settingsSouth African Medical AssociationSAMJ: South African Medical Journal v.106 n.4 20162016-04-01journal articletext/htmlhttp://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000400024en |
institution |
SCIELO |
collection |
OJS |
country |
Sudáfrica |
countrycode |
ZA |
component |
Revista |
access |
En linea |
databasecode |
rev-scielo-za |
tag |
revista |
region |
África del Sur |
libraryname |
SciELO |
language |
English |
format |
Digital |
author |
de Waal,R Cohen,K Fox,M P Stinson,K Maartens,G Boulle,A Davies,M-A |
spellingShingle |
de Waal,R Cohen,K Fox,M P Stinson,K Maartens,G Boulle,A Davies,M-A Clinician compliance with laboratory monitoring and prescribing guidelines in HIV 1-infected patients receiving tenofovir |
author_facet |
de Waal,R Cohen,K Fox,M P Stinson,K Maartens,G Boulle,A Davies,M-A |
author_sort |
de Waal,R |
title |
Clinician compliance with laboratory monitoring and prescribing guidelines in HIV 1-infected patients receiving tenofovir |
title_short |
Clinician compliance with laboratory monitoring and prescribing guidelines in HIV 1-infected patients receiving tenofovir |
title_full |
Clinician compliance with laboratory monitoring and prescribing guidelines in HIV 1-infected patients receiving tenofovir |
title_fullStr |
Clinician compliance with laboratory monitoring and prescribing guidelines in HIV 1-infected patients receiving tenofovir |
title_full_unstemmed |
Clinician compliance with laboratory monitoring and prescribing guidelines in HIV 1-infected patients receiving tenofovir |
title_sort |
clinician compliance with laboratory monitoring and prescribing guidelines in hiv 1-infected patients receiving tenofovir |
description |
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 CONLUSIONS: 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 |
publisher |
South African Medical Association |
publishDate |
2016 |
url |
http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000400024 |
work_keys_str_mv |
AT dewaalr cliniciancompliancewithlaboratorymonitoringandprescribingguidelinesinhiv1infectedpatientsreceivingtenofovir AT cohenk cliniciancompliancewithlaboratorymonitoringandprescribingguidelinesinhiv1infectedpatientsreceivingtenofovir AT foxmp cliniciancompliancewithlaboratorymonitoringandprescribingguidelinesinhiv1infectedpatientsreceivingtenofovir AT stinsonk cliniciancompliancewithlaboratorymonitoringandprescribingguidelinesinhiv1infectedpatientsreceivingtenofovir AT maartensg cliniciancompliancewithlaboratorymonitoringandprescribingguidelinesinhiv1infectedpatientsreceivingtenofovir AT boullea cliniciancompliancewithlaboratorymonitoringandprescribingguidelinesinhiv1infectedpatientsreceivingtenofovir AT daviesma cliniciancompliancewithlaboratorymonitoringandprescribingguidelinesinhiv1infectedpatientsreceivingtenofovir |
_version_ |
1756005786166755328 |