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

The Highly Active Antiretroviral Therapy Oversight Committee.

Long-term comparative and prospective cohort study of renal function in patients with HIV infection treated with tenofovir disoproxil fumarate

“…While most previously published works with shorter follow-up periods have found little variation of the eGFR related to TDF use [6], some observational studies with longer follow-up periods have found CRDRF related with TDF use [13][14][15][16][17]. It is worth mentioning some considerations about these studies.…”

“…It is worth mentioning some considerations about these studies. Some of them have been conducted in specific populations such as African population [16], among patients with low body weight [15], or treatment-naïve patients [17], and others have used the Cockcroft-Gault equation to estimate the creatinine clearance [13], which can result in an overestimate of the creatinine clearance. These situations might explain why our study shows a higher incidence of chronic kidney disease related to TDF use in the long term.…”

“…Moreover, large clinical trials with long follow-up periods of more than 144 weeks in naïve patients have shown a renal safety profile of ART containing TDF, either similar to other ART without it, or with small significant declines in the estimated glomerular filtration rate (eGFR) of clinical implications difficult to ascertain [7][8][9]. Observational studies with longer follow-up periods suggest a more deleterious effect on the renal function, and point that TDF is associated with a higher incidence of chronic kidney disease [10][11][12][13][14][15][16][17]. Overall, these results have shown either a modest or absent decline in renal function associated with TDF use after short follow-up periods of months or very few years, while studies with longer follow-up periods suggest a more relevant decrease in renal function [13][14][15][16][17].…”

Ultrasonic Measurement of Kidney Length in Nepalese People

“…Many studies have shown that in various diseases kidney size changes, which is probably due to inflammation resulting from infections and by concentration of water and minerals. Diabetes can also increase the size of kidney and many other chronic diseases can decrease the size of kidney (Mogensen et al, 1973;Mohammed et al, 2016, Mocroft et al, 2016. Moreover, the dating of pregnancy in second and third trimesters is very reliable from ultrasound parameters.…”

The benefits and risks of PrEP and kidney function

“…Evidence on the use of tenofovir-alafenamide (TAF) as part of PrEP is currently limited, but results from HIV-positive persons suggest a more favourable renal profile 16 , which may make it an alternative for those at highest risk of renal disease. TDF has been reported to be associated with renal toxicities in HIV-positive persons enrolled in cohort studies, with increasing risk of chronic kidney disease as exposure to TDF increases [5][6][7] . This result was not evident in clinical trials demonstrating clinical efficacy of TDF in HIV-positive persons, many of which demonstrated an initial decline in estimated glomerular filtration rate associated with TDF limited to the first few months of treatment 8;9 .…”