Effect of changing from first- to second- line antiretroviral therapy on renal function: a retrospective study based on data from a single health facility in Namibia

Tenofovir disoproxil fumarate (TDF) and lopinavir/ritonavir (LPV/r) can cause renal impairment with this combination co-administered during second-line combination antiretroviral therapy (cART) potentially associated with greater risk of nephrotoxicity. Objective: Assess effects of second-line cART on renal function. Methods: Retrospective longitudinal study in patients receiving cART. Results: 71 patients received TDF, zidovudine or stavudine, each combined with 3TC/NVP or 3TC/ EFV. Before second-line cART, 46.5% had abnormal kidney function. First-line cART had no relationship with calculated creatinine clearance (CrCl). During second-line cART, more males than females had abnormal renal function and more females experienced increases in CrCl. Calculated CrCl during second-line cART related strongly with CrCl during first-line cART; time spent on cART weak relationship with CrCl. Conclusion: Patients on first-line cART for several years without renal impairment may experience new onset impairment during cART. Patients with pre-existing renal impairment just before switching to second-line cART may experience a further decline.