ART Combination Strongly Linked to Kidney Disease

Second line antiretroviral therapy (ART) with ritonavir and lopinavir (LPV/r) co-administered with tenofovir (TDF) is strongly associated with tubular dysfunction (TD) and chronic kidney disease (CDK), according to the results of a recent study.

The use of second line ART with LPV/r has increased in recent years, but at this time, little is known about the safety of TDF co-administration with LPV/r.
____________________________________________________

RELATED CONTENT
In HIV, CV Risk is Higher in Men
Poll: Does lung function affect mortality risk in HIV patients?
____________________________________________________

In their study, the researchers collected data from 1382 HIV-infected patients in Vietnam in October 2014 and October 2015. They defined TD as urinary beta 2 microglobulin (β2MG) > 1000 μg/L at both timepoints or increase in β2MG by > 2000 μg/L. CKD was defined as creatinine clearance ≤60 ml/min or urinary protein/creatinine ratio ≥ 0.15 g/gCre at both timepoints.

Overall, 98.2% of the participants were on ART, 76.3% were on TDF, and 22.4% had never TDF exposure. TD and CKD were diagnosed in 13% and 8.3% of participants, respectively.

Increased risk of TD was associated with age (odds ratio [OR] 1.057), female sex (OR 0.377), HBsAg positive status (OR 1.812), HCVAb positive status (OR 1.703), TDF exposure (OR 9.226), and LPV/r exposure (OR 5.548). Increased CKD risk was associated with age (OR 1.093), female sex (OR 0.510), weight (OR 0.909), hypertension (OR 3.027), TDF exposure (OR 1.963) and LPV/r exposure (OR 3.122).

“TDF and LPV/r exposure were strongly associated with TD and CKD, in addition to their known risks. Therefore, attention to renal safety for patients on second line ART is necessary,” the researchers concluded.

—Michael Potts

Reference:

Mizushima D, Nguyen DTH, Nguyen DT, et al. Tenofovir disoproxil fumarate co-administered with lopinavir/ritonavir is strongly associated with tubular damage and chronic kidney disease [published online March 27, 2018]. J Infect Chemother. https://doi.org/10.1016/j.jiac.2018.03.002

Interested in HIV? Check out this podcast!