Participants were evaluated for standard clinical, virologic, immunologic, and adherence parameters at weeks 2 and 4 following enrollment (interrupted arms only, not included in outcome analysis) and every 6 weeks thereafter including toxicity monitoring (renal toxicity, ALT and AST were evaluated every 12 weeks and lipid profiles were done every 6 months).
When TDF is used with PI/r in second line regimens in RLS, monitoring for renal toxicity is warranted.
17 As a PV exemplar in Uganda, the NPC and AIDS Control Programme introduced TSR in 2011 to monitor tenofovir for renal toxicity and to detect suspected ADRs related to antiretroviral therapy use in the Prevention of Mother to Child Transmission of HIV and in the Early Infants Diagnosis programme.
The health professionals managing patients were trained on the TSR methodology and renal toxicity monitoring as well as any other safety concerns.
Additionally, due to the risk of renal toxicity, renal monitoring is recommended before each intravenous (IV) bisphosphonate infusion.
Unfortunately, ototoxicity cannot be monitored in critically ill patients, while renal toxicity can only be assessed in a large prospective controlled design if baseline renal function is documented.
We attribute this to the increased sensitivity of our team regarding renal toxicity, to closer monitoring of fluid balance and renal functions in colistin users, and to the avoidance of the use of concomitant nephrotoxic agents.
Health workers in the pilot facilities were trained to monitor for signs and symptoms of tenofovir renal toxicity in all patients that were initiating or were already on tenofovir-based regimens.
Current recommendations are based on these later trials, favouring a high peak serum concentration using high doses of aminoglycoside as boluses and close monitoring of residual serum concentrations to avoid renal toxicity.
However, because of risk of renal toxicity, the kidneys shoud be monitored carefully [ 49].
