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RESEARCH ARTICLE
Contents Vol 22(3)

Renal impairment risk in Indigenous and non-Indigenous people who take HIV pre-exposure prophylaxis (PrEP): a retrospective cohort study

D. Drak https://orcid.org/0000-0001-6900-2029 A * , H. McManus B , T. Vickers B , J. Salerno C , M. Tobin D , J. T. Hughes E F , D. A. Lewis G H , A. Carter https://orcid.org/0000-0003-2151-2622 B , D. Russell I J , M. Gunathilake K , H. Ali L M , R. Guy B , C. C. O’Connor B , J. Ward N , D. M. Gracey A O and on behalf of ACCESS
+ Author Affiliations
- Author Affiliations

A Central Clinical School, University of Sydney, Camperdown, NSW, Australia.

B Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

C Health Equity Matters, Surry Hills, NSW, Australia.

D Positive Life NSW, Surry Hills, NSW, Australia.

E Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.

F Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia.

G Western Sydney Sexual Health Centre, Parramatta, NSW, Australia.

H Westmead Clinical School, Faculty of Medicine and Health and Sydney Institute for Infectious Diseases, University of Sydney, Westmead, NSW, Australia.

I Cairns Sexual Health Service, Cairns North, Qld, Australia.

J James Cook University, Townsville, Qld, Australia.

K Sexual Health & Blood Borne Virus Unit of Centre for Disease Control, Northern Territory Department of Health, Tiwi, NT, Australia.

L The University of Queensland, St Lucia, Qld, Australia.

M Brown University, Providence, RI, USA.

N Poche Centre for Indigenous Health, The University of Queensland, Herston, Qld, Australia.

O Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.

* Correspondence to: ddra8845@alumni.sydney.edu.au

Handling Editor: Cheng Wang

Sexual Health 22, SH24149 https://doi.org/10.1071/SH24149
Submitted: 31 July 2024  Accepted: 22 March 2025  Published: 22 April 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing

Abstract

Background

Tenofovir disoproxil-containing HIV pre-exposure prophylaxis (PrEP) is associated with a small risk of renal impairment. How this risk may differ in Aboriginal and Torres Strait Islander peoples (hereafter, respectfully, ‘Indigenous’) who have higher rates of chronic kidney disease and associated risk factors than non-Indigenous Australians, has yet to be described.

Methods

A retrospective longitudinal open cohort study of adults with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 commencing tenofovir disoproxil-containing PrEP as part of routine care was conducted. Client data were collected from 67 clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses network between January 2012 and December 2019. The primary outcome was the rate of new renal impairment, defined as an eGFR of <60 mL/min/1.73 m2 or >25% decline of eGFR from baseline.

Results

Of the 8696 adults, 203 identified as Indigenous and were eligible for inclusion. The median age was 34 years (IQR 28–44), 96.8% were men who have sex with men and 90.1% resided in major cities. Indigenous clients were less likely to have a baseline eGFR 60–90 mL/min/1.73 m2 (15.8% vs 24.1%; P = 0.006). Over a median follow-up period of 1.7 years (IQR 1.1–2.4), rates of renal impairment were similar for Indigenous and non-Indigenous clients: 5.6 events/1000 person-years (95% CI 1.4–22.8) and 4.8 events/1000 person-years (95% CI 3.9–6.1) respectively (P = 0.83).

Conclusions

Renal impairment was rare among Australians commencing PrEP as part of usual care. We observed no difference in the development of renal impairment among Indigenous and non-Indigenous Australians.

Keywords: Aboriginal and Torres Strait Islander health, chronic kidney disease, HIV, kidney, men who have sex with men (MSM), pre-exposure prophylaxis, renal impairment, sexual health, tenofovir disoproxil.

References

1  Grulich AE, Guy R, Amin J, Jin F, Selvey C, Holden J, et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV 2018; 5(11): e629-e37.
| Crossref | Google Scholar | PubMed |

2  McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387(10013): 53-60.
| Crossref | Google Scholar |

3  The Australian Society for HIV Viral Hepatitis and Sexual Health Medicine. National PrEP Guidelines Update. Prevent HIV by Prescribing PrEP. Sydney: The Australian Society for HIV Viral Hepatitis and Sexual Health Medicine; 2021.

4  The Kirby Institute. Monitoring HIV pre-exposure prophylaxis (PrEP) uptake in Australia. (Issue 7); 2022. Available at https://www.kirby.unsw.edu.au/sites/default/files/documents/Monitoring-HIV-PrEP-uptake-in-Australia-newsletter_Issue7.pdf

5  Australian Government – Department of Health and Aged Care. The Pharmaceutical Benefits Scheme; 2023. Available at www.pbs.gov.au

6  Gandhi M, Glidden DV, Mayer K, Schechter M, Buchbinder S, Grinsztejn B, et al. Association of age, baseline kidney function, and medication exposure with declines in creatinine clearance on pre-exposure prophylaxis: an observational cohort study. Lancet HIV 2016; 3(11): e521-e8.
| Crossref | Google Scholar | PubMed |

7  Tang EC, Vittinghoff E, Anderson PL, Cohen SE, Doblecki-Lewis S, Bacon O, et al. Changes in kidney function associated with daily tenofovir disoproxil fumarate/emtricitabine for HIV preexposure prophylaxis use in the United States demonstration project. J Acquir Immune Defic Syndr 2018; 77(2): 193-8.
| Crossref | Google Scholar |

8  Drak D, McManus H, Vickers T, Heron JE, Vaccher S, Zablotska I, et al. Renal impairment in a large-scale HIV preexposure prophylaxis implementation cohort. AIDS 2021; 35(14): 2319-26.
| Crossref | Google Scholar |

9  Hall AM, Hendry BM, Nitsch D, Connolly JO. Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence. Am J Kidney Dis 2011; 57(5): 773-80.
| Crossref | Google Scholar |

10  Cass A, Cunningham J, Wang Z, Hoy W. Regional variation in the incidence of end-stage renal disease in Indigenous Australians. Med J Aust 2001; 175(1): 24-7.
| Crossref | Google Scholar |

11  Australian Institute of Health and Welfare. Cardiovascular disease, diabetes and chronic kidney disease — Australian facts: Aboriginal and Torres Strait Islander people. Canberra: Australian Institute of Health and Welfare; 2015.

12  Marcus JL, Hurley LB, Hare CB, Nguyen DP, Phengrasamy T, Silverberg MJ, et al. Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and discontinuation. J Acquir Immune Defic Syndr 2016; 73(5): 540-6.
| Crossref | Google Scholar |

13  Stumpers S, Thompson N. Review of kidney disease among Indigenous people. Aust Indig Health Bull 2013; 13: 1-22.
| Google Scholar |

14  White A, Wong W, Sureshkumur P, Singh G. The burden of kidney disease in Indigenous children of Australia and New Zealand, epidemiology, antecedent factors and progression to chronic kidney disease. J Paediatr Child Health 2010; 46(9): 504-9.
| Crossref | Google Scholar |

15  Guy R, Lim MSC, Wang Y-HJ, Medland N, Anderson J, Roth N, et al. A new surveillance system for monitoring HIV infection in Victoria, Australia. Sex Health 2007; 4(3): 195-9.
| Crossref | Google Scholar |

16  Callander D, Moreira C, El-Hayek C, Asselin J, van Gemert C, Watchirs Smith L, et al. Monitoring the control of sexually transmissible infections and blood-borne viruses: protocol for the Australian collaboration for coordinated enhanced sentinel surveillance (ACCESS). JMIR Res Protoc 2018; 7(11): e11028.
| Crossref | Google Scholar |

17  Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int 2011; 80(1): 17-28.
| Crossref | Google Scholar |

18  Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey Canberra; 2019. Available at https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release

19  Australian Institute of Health and Welfare. Profile of First Nations people. Canberra: AIHW; 2023.

20  Hope A, Haire B. “No-one’s driving this bus” – qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men. Aust N Z J Public Health 2019; 43(1): 18-23.
| Crossref | Google Scholar | PubMed |

21  Stajic J, Carson A, Ward J. Rationale and plan for a focus on First Nations urban health research in Australia. Med J Aust 2024; 220(2): 64-6.
| Crossref | Google Scholar |

22  Mocroft A, Lundgren JD, Ross M, Fux CA, Reiss P, Moranne O, et al. Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate: a prospective international cohort study. Lancet HIV 2016; 3(1): e23-32.
| Crossref | Google Scholar | PubMed |

23  Coy KC, Hazen RJ, Kirkham HS, Delpino A, Siegler AJ. Persistence on HIV preexposure prophylaxis medication over a 2-year period among a national sample of 7148 PrEP users, United States, 2015 to 2017. J Int AIDS Soc 2019; 22(2): e25252.
| Crossref | Google Scholar |

24  Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med 2015; 373(23): 2237-46.
| Crossref | Google Scholar |

25  Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, et al. Australasian society for HIV, viral hepatitis and sexual health medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad 2018; 4(2): 143-59.
| Crossref | Google Scholar |

26  Ascher SB, Scherzer R, Estrella MM, Shigenaga J, Spaulding KA, Glidden DV, et al. HIV preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and changes in kidney function and tubular health. AIDS 2020; 34(5): 699-706.
| Crossref | Google Scholar |

27  Mugwanya KK, Wyatt C, Celum C, Donnell D, Kiarie J, Ronald A, et al. Reversibility of glomerular renal function decline in HIV-uninfected men and women discontinuing emtricitabine-tenofovir disoproxil fumarate pre-exposure prophylaxis. J Acquir Immune Defic Syndr 2016; 71(4): 374-80.
| Crossref | Google Scholar |

28  Kelly MD, Gibson A, Bartlett H, Rowling D, Patten J. Tenofovir-associated proteinuria. AIDS 2013; 27(3): 479-81.
| Crossref | Google Scholar |