Renal safety of lithium in HIV-infected patients established on tenofovir disoproxil fumarate containing antiretroviral therapy : analysis from a randomized placebo-controlled trial
Date
2017-02-04
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: The prevalence of bipolar disorder in HIV-infected patients is higher than the general population.
Lithium is the most effective mood stabiliser, while tenofovir disoproxil fumarate (TDF) is frequently used as part of
combination antiretroviral therapy (ART). Both TDF and lithium are associated with renal tubular toxicity, which could
be additive, or a pharmacokinetic interaction may occur at renal transporters with a decrease in TDF elimination.
Objective: We report on the change in estimated glomerular filtration rate (eGFR) using the modification of diet in
renal disease formula in participants who received ART including TDF and were enrolled in a 24 week randomised trial
of lithium versus placebo in patients with HIV-associated neurocognitive impairment.
Methods: We included HIV-infected adults with cognitive impairment established on ART for at least 6 months with
a suppressed viral load attending public sector ART clinics in Cape Town, South Africa. We excluded participants with
an eGFR <60 mL/min and treated with medications predisposing to lithium toxicity. We reviewed participants weekly
for the first month for adverse events followed by 4 weekly visits for renal function assessment, adverse event monitoring
and adherence. Lithium dose was titrated to achieve the maintenance target plasma concentration of between
0.6 and 1.0 mmol/L. Sham lithium concentrations were generated for participants receiving placebo.
Results: We included 23 participants allocated to the lithium arm and 30 participants allocated to the placebo arm.
Baseline characteristics were not statistically different with a mean age of 37.7 and 40.8 years, a median time on ART of
33 and 40 months and an eGFR of 139.3 and 131.0 mL/min in the lithium and placebo arms respectively. There was no
statistical significant difference in the reduction in eGFR or increase in potassium between the two arms during the
24 weeks.
Conclusions: We found that 24-week treatment of HIV-infected patients with lithium and TDF did not result in
increased nephrotoxicity.
Description
CITATION: Decloedt, Eric H., et al. 2017. Renal safety of lithium in HIV-infected patients established on tenofovir disoproxil fumarate containing antiretroviral therapy : analysis from a randomized placebo-controlled trial. AIDS Research and Therapy, 14:6, doi:10.1186/s12981-017-0134-2.
The original publication is available at http://aidsrestherapy.biomedcentral.com
The original publication is available at http://aidsrestherapy.biomedcentral.com
Keywords
Lithium -- Therapeutic use, HIV-positive persons, Kidney toxicity
Citation
Decloedt, Eric H., et al. 2017. Renal safety of lithium in HIV-infected patients established on tenofovir disoproxil fumarate containing antiretroviral therapy : analysis from a randomized placebo-controlled trial. AIDS Research and Therapy, 14:6, doi:10.1186/s12981-017-0134-2