Dear Dr. Muchinta,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Abdulwasiu Bolaji Tiamiyu, MBBS, FMCP

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: 1.. Although your experiment was conducted rigorously and appropriate data obtained, some of your conclusions were based on comparison with a study in patients with Hepatitis B. The study will be more robust and the conclusion more validated if you had used HIV patients without tenofovir toxicity as your controls. As it is now, your conclusion that HIV patients with Tenofovir toxicity have an increased risk of CKD can not be validated

2. There is no description of patients’ baseline characteristics apart from age, gender and baseline creatinine. What about other clinicodemographic characteristics such as smoking status, level of alcohol intake, consumption of herbal medications, BMI, CD4 count levels, viral load, proteinuria level, Haematocrit and presence of other comorbidities like hypertension and Diabetes Mellitus. Adding this to your result section will make your result more robust, provide a better platform for comparison with other studies and allow for determining if your result is applicable to other patient populations. It would also allow you to perform more univariate analyses to determine factors associated with development of CKD in patients with tenofovir toxicity.

Reviewer #2: The manuscript is technically sound and the data provided supported the claims and findings. The data is also made available. The language of the manuscript is appropriate for scholastic communication. The statitical analysis was performed appropriately and scientifically sound. The study aimed to determine the association between TDF-induced nephrotoxicity at three months and chronic kidney disease (CKD) within five years among people living with HIV (PLWH) in Zambia. The findings indicated a significant association between TDF-associated nephrotoxicity and the

development of CKD within five years. This claim was properly placed in contex of previous literature as the author conducted extensive literature review. The data analyses fully supported the claims. The study protocol was meticulously explained. The study conformed to relevant guidelines. The methodology was comprehensive enough to allow other researchers to replicate it in other centers. The language of the manuscript is clear enough to be accessible to those who are not specialists in the field.

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Reviewer #1: Yes:  Dr Habibu Aliyu Galadanci

Reviewer #2: Yes:  DR MOJEED OLAITAN RAFIU

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Chronic Kidney Disease among HIV-positive Zambian adults with Tenofovir-associated Nephrotoxicity at University Teaching Hospital (UTH) in Lusaka.

PONE-D-25-19997R1

Dear Dr. Muchinta,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Abdulwasiu Bolaji Tiamiyu, MBBS, FMCP

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: