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.
Abstract | BACKGROUND: Whether or not the association between some antiretrovirals used in HIV infection and chronic kidney disease is cumulative is a controversial topic, especially in patients with initially normal renal function. In this study, we aimed to investigate the association between duration of exposure to antiretrovirals and the development of chronic kidney disease in people with initially normal renal function, as measured by estimated glomerular filtration rate (eGFR). METHODS: FINDINGS: Between Jan 1, 2004, and July 26, 2013, 23,905 eligible individuals from the D:A:D study were included. Participants had a median baseline eGFR of 110 mL/min per 1·73 m(2) (IQR 100-125), a median age of 39 years (33-45), and median CD4 cell count of 441 cells per mm(3) (294-628). During a median follow-up of 7·2 years (IQR 5·1-8·9), 285 (1%) of 23,905 people developed chronic kidney disease (incidence 1·76 per 1000 person-years of follow-up [95% CI 1·56-1·97]). After adjustment, we recorded a significant increase in chronic kidney disease associated with each additional year of exposure to tenofovir disoproxil fumarate (adjusted incidence rate ratio 1·14 [95% CI 1·10-1·19], p<0·0001), ritonavir-boosted atazanavir (1·20 [1·13-1·26], p<0·0001), and ritonavir-boosted lopinavir (1·11 [1·06-1·16], p<0·0001), but not other ritonavir-boosted protease inhibitors or abacavir. INTERPRETATION: FUNDING:
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Authors | Amanda Mocroft, Jens D Lundgren, Michael Ross, Christoph A Fux, Peter Reiss, Olivier Moranne, Philippe Morlat, Antonella d'Arminio Monforte, Ole Kirk, Lene Ryom, Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) Study |
Journal | The lancet. HIV
(Lancet HIV)
Vol. 3
Issue 1
Pg. e23-32
(Jan 2016)
ISSN: 2352-3018 [Electronic] Netherlands |
PMID | 26762990
(Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Copyright | Copyright © 2016 Elsevier Ltd. All rights reserved. |
Chemical References |
- Anti-HIV Agents
- Atazanavir Sulfate
- Tenofovir
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Topics |
- Adolescent
- Adult
- Anti-HIV Agents
(adverse effects, therapeutic use)
- Atazanavir Sulfate
(adverse effects, therapeutic use)
- Australia
- Europe
- Female
- Glomerular Filtration Rate
(drug effects)
- HIV Infections
(complications, drug therapy)
- Humans
- Male
- Middle Aged
- Prospective Studies
- Renal Insufficiency, Chronic
(etiology, physiopathology)
- Tenofovir
(adverse effects, therapeutic use)
- United States
- Young Adult
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