Prevalence and Associated Factors of Fanconi Syndrome among HIV Patients Receiving Tenofovir Disoproxil Fumarate at Phayao Hospital: A Retrospective Cohort Study

Abstract

     This survey research by retrospective cohort study aimed to determine the prevalence of Fanconi syndrome or proximal renal tubulopathy (PRT) and to explore associated factors among HIV patients receiving tenofovir disoproxil fumarate (TDF) at Phayao Hospital. Data were retrieved from medical records and HIV clinic databases. Eligible patients were aged 18 years or older and had received a TDF-containing antiretroviral regimen for at least six months. Descriptive statistics were used to summarize patient characteristics, laboratory monitoring, and renal tubular abnormalities. Univariable and limited multivariable logistic regression analyses were performed to identify factors associated with Fanconi syndrome/PRT.

     A total of 2,003 patients were included. Most were male (55.1%), with a median age of 47 years (IQR 37–53) and a median body mass index of 21.27 kg/m² (IQR 19.30–23.73). At least one non-communicable disease was present in 32.5% of patients, including hypertension in 25.9% and diabetes mellitus in 10.6%. Long-term TDF exposure of more than 36 months was observed in 75.0%. Laboratory monitoring showed availability of creatinine in 96.9%, estimated glomerular filtration rate in 89.6%, urine protein/urine glucose in 66.9%, serum uric acid in 31.0%, and serum phosphorus in 28.5%. The observed abnormalities were proteinuria in 8.4%, hypophosphatemia in 2.8%, and normoglycemic glycosuria in 0.7%. Fanconi syndrome/PRT was identified in 30 patients, corresponding to a prevalence of 1.5%. In the limited multivariable model, male sex (adjusted OR 3.87, 95%CI 1.61–9.33, p=0.003), presence of at least one non-communicable disease (adjusted OR 4.21, 95%CI 1.91–9.25, p<0.001), and TDF exposure of more than 36 months (adjusted OR 4.15, 95%CI 1.42–12.10, p=0.009) were significantly associated with Fanconi syndrome/PRT.