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Tenofovir increase kidney risk.
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Tenofovir increase kidney risk.

Hi all,

A report about tenofovir. Should HBVers change to entecavir and if yes what is the long term safety for entecavir ?

Please adivse

Link : http://www.hivandhepatitis.com/hiv-side-effects/293,341-kidney-toxicity-kidney-toxicity/3457-large-study-finds-tenofovir-linked-to-increased-kidney-risk
Tags: tenofovir
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Avatar_m_tn

that's hiv not hbv, nothing to do with us

as regards hbv no kidneys toxicity has been linked to tenofovir use since it was only in less than 1% patients which had already kidneys problems probably because of liver fibrosis

liver fibrosis and cirrhosis is linked with kidneys damage and also hbv is, after use of hbv antivirals there is often improvment of creatinine clearance

i ve used entecavir and still use it on combo but i dont like it personally because too weak and because resistance is possible on it especially if undetected lam mutants are present and they are present in naive patients too

as regards sides i fear entecavir much more because of the mice lung tumors at dose just a little higher than human, my hope is to discontinue both after some years thanks to combo withinterferon and hbv clearance
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Avatar_m_tn

that's hiv not hbv, nothing to do with us

as regards hbv no kidneys toxicity has been linked to tenofovir use since it was only in less than 1% patients which had already kidneys problems probably because of liver fibrosis

liver fibrosis and cirrhosis is linked with kidneys damage and also hbv is, after use of hbv antivirals there is often improvment of creatinine clearance

i ve used entecavir and still use it on combo but i dont like it personally because too weak and because resistance is possible on it especially if undetected lam mutants are present and they are present in naive patients too

as regards sides i fear entecavir much more because of the mice lung tumors at dose just a little higher than human, my hope is to discontinue both after some years thanks to combo withinterferon and hbv clearance
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Avatar_m_tn
the long term safety for entecavir ?

it is used sine about 7 years so we dont know longterm safety, it was put on market with striked cancer surveillance
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Avatar_m_tn

for those with kidneys toxicities of any kind fibroguard is able to lower creatinine too

i had creatinine increase in 2010 to 1.21 (normal 0.7-1.2) during use of alinia+entecavir, using fibroguard creatinine lowered to minimum normal range

i tried to stop fibroguard to see if it was keeping creatinine low and without it creatinine did increase.today i am on etv+tdf with no effect on creatinine, calcium and phosphorus thanks to fibroguard
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Avatar_m_tn
Thanks for your info.

This means we have to test our kidneys before & during medication.
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Avatar_m_tn

yes it should be done monthly at first and then every 3 to 6 months because there are no tests to detect kidneys damage, all tests available today are very poor sensibility, so people starting tdf with a kidneys disease can be detected only by baseline creatinine clearance and then frequent tests first 6 months

i used creatinine clearance wth urine collection 24hrs at baseline and then continue to follow with creatinine serum ,phosphorus, calcium monitoring
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Avatar_m_tn
Stef,

While I see the original study looked at people with HIV, the study was looking at kidney damage from taking TDF, not kidney damage from HIV, so I don't see why this would not apply to people with HBV?  If TDF is causing damage to those people's kidneys, why wouldn't the same happen to our kidneys from taking TDF?
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Avatar_m_tn
simply because all patients with hbv taking tdf had no effect on kidneys for 6-7 years of using tdf and comparing with other antivirals etv and adv had the most effect on kidneys

those claims are all wrong and now the people taking tdf proved it, i was also concerned since alinia made my creatinine 1.2 in 2010 (which is still normal range) but tenofovir did nott have any effect on my kidneys, and even if one has this concern the use of fibrogard and antioxidants make kidneys able to handle whatever
infact i am on etv+tdf and used alinia too in january and no effect at all on kidneys with all the antioxidants i take actually kidneys where much worst when hbv was active because hbv can damage kidneys much more than tdf

quite the opposite has even been found, tenofovir cures damaged kidenys even in combo with other antiviral

tenofovir+telbivudine cure and improves kidneys function on damaged kidneys
there is also a study about a trial of hbv patients with liver damage due to hbv, the disease is called membranous glomerulonephritis

http://www.uptodate.com/contents/renal-disease-associated-with-hepatitis-b-virus-infection

AASLD 2011
http://www.multiwebcast.com/aasld/2011/thelivermeeting/13791/
Background
The leading cause of liver cirrhosis globally is Chronic Hepatitis B (CHB). CHB often leads to decompensation which then leads to renal insufficiency. Nucleot(s)ide treatment may prevent or delay liver failure for CHB pts providing more time for transplantation. A recent study of decompensated CHB pts showed that renal function significantly improved for pts receiving telbivudine (LDT) but continually worsened for pts receiving Lamivudine (LAM). Renal dysfunction can reduce clearance of oral nucleot(s)ides increasing drug-associated toxicities resulting with high mortality.
Methods
We performed a meta-analysis of pooled data to determine the effect of LDT vs LAM treatment on renal function of CHB pts. MDRD (Modification of Diet in Renal Disease) was used to measure renal function from four LDT clinical trials: LDT vs LAM (n=1370); LDT for 4-years (n=1869); 2 years LDT vs LAM in decompensated patients (n=232); prospective LDT roadmap study with tenofovir (TDF) add-on (n=105). Renal function was assessed at baseline (BL), Week 52 (W52), W104 and W208.
Conclusion
Compensated and decompensated CHB pts receiving telbivudine or telbivudine plus tenofovir have a reliable improvement in renal function. Additional studies will help to understand the mechanism of this protective effect.
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Avatar_m_tn
https://docs.google.com/open?id=0B8E77QizhkLQMTljR1BudHVUT09NTS1IMHlCVGlpZw

poster tenofovir+telbivudine on kidneys disease

keeping hbv infection itself damages kidneys more than antivirals on patients developing fibrosis, infact kidneys are more damaged as fibrosis increases and antivirals and drugs are not tollerated.

my guess
it is possible that hiv patients have damaged livers by toxicities of the combos antivirals and as a consequence kidneys are damaged as well and cannot tollerate tdf
also most hiv patients come from drug use and extremely unhealthy life styles so livers and kidneys as well as their immmune sstems are severely damaged much before discovery of hiv positivty and use of antivirals.
my thinking is that hiv patients are not good at all to compare to other patients and diseases
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Avatar_m_tn

finally when you get to cirrhosis level, especially decompensated you also get kidneys failure, these organs are connected, so any patients must simply monitor everything just like it is routinely done, at least in europe, and no problems ever occurs because as you see a small change in creatinine you just add antioxidants

my creatinine before any hbv treatment in 2009, between 0.95-1.00mg/dl
my creatinine after hbv treatment with entecavir+tenofovir+heptech 0.8mg/dl (the minimum normal range is 0.7)

also keeping normal cholesterol levels and optimum ranges improves kidneys function and prevents kidneys damage
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Avatar_m_tn

my creatinine clearance, which is a better measure of kidneys function, is also 107mg/dl/min with no heptech and 118mg/dl/min with heptech (creat clearance range Male: 97 to 137 ml/min.Female: 88 to 128 ml/min), today probably even better because i only checked it when i had creatinine increase from 1.05 to 1.2
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Avatar_n_tn
I am using tenofovir. Now, my creatinine is lower than lower range (result from Pasteur Institute). Is this a problem?
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Avatar_m_tn

no it is an improvment, it means your kidneys were affected my hbv probably and now they work even better
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