Kidney Disease in HIV Infection

Alfano, Gaetano; Cappelli, Gianni; Fontana, Francesco; Lullo, Luca Di; Iorio, Biagio Di; Bellasi, Antonio; Guaraldi, Giovanni

doi:10.3390/jcm8081254

Cited by 42 publications

(46 citation statements)

References 120 publications

(137 reference statements)

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“…This phenomenon can not be explained explicitly thus far. 32 A speculation of far from mature is that TDF, as a wellknown nephrotoxic antiretroviral, causes a rapid stress in renal tubular at the beginning exposure followed by a transient recovery possibly from the self-repairing mechanisms of kidney; then, an inevitable damage occurs if beyond the ability of self repairment over time. 33 Among TDF users, during the increasing period (1.40-2.30 years) of eGFR, the incidences of both outcomes, especially RKFD definitely declined (suggesting a recovery of renal function), even though TDF continued.…”

Section: Discussionmentioning

confidence: 99%

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

Liu

Zhao

et al. 2020

TCRM

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Purpose: Estimated glomerular filtration rate (eGFR) decline in HIV-1-infected patients exposure to tenofovir disoproxil fumarate (TDF) has been widely assessed using linear models, but nonlinear assumption is not well validated. We constructed a retrospective cohort study to assess whether eGFR decline follows nonlinearity during antiviral therapy. Patients and Methods: We examined 823 (299 of TDF users and 524 of non-TDF users) treatment-naïve HIV-1-infected participants (age ≥ 17 years, initial eGFR ≥ 90 mL/min/1.73m 2). Estimated GFR trajectories were compared by one-linear and piecewise-linear mixed effects models, before and after propensity score matching, respectively. Whether the incidence of renal dysfunction (reduced renal function [RRF], eGFR < 90 mL/min/1.73 m 2 and rapid kidney function decline [RKFD], eGFR > −3 mL/min/1.73 m 2 /year) follows nonlinearity was assessed by logistic regression. Results: The median follow-up time of this study was 10 (interquartile range, 2-20) months, during which 178 (21.6%) experienced RRF, and 451 (54.8%) experienced RKFD. The slopes (mL/min/1.73 m 2 /year) of eGFR were −5.31 (95% CI: −6.57, −4.06) before 1.40 years, 4.83 (95% CI: 1.38, 8.28) from years 1.40 to 2.30 and −3.71 (95% CI: −5.97, −1.45) after 2.30 years among TDF users. Within years 1.40-2.30, each year of TDF exposure was associated with a 78% decreased risk of RKFD (95% CI: −91%, −49%). In comparison, eGFR increased slightly at the initiation of antiviral therapy, declined after 2.15 years (−4.96; 95% CI: −5.76, −4.17) among non-TDF users. Such a progression nonlinear trajectory was missed on the assumption of one-linearity, whether in TDF or non-TDF users. Conclusion: Over the piecewise mixed-effects analyses with the advantage of revealing the true nature of the exposure outcome relationships, an interesting reverse S-shaped relationship was observed. A routine screen based on nonlinearity could be more helpful for patient management.

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Section: Discussionmentioning

confidence: 99%

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

Liu

Zhao

et al. 2020

TCRM

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“…Kidney transplantation in HIV‐infected patients is nowadays a safe and effective treatment of end‐stage renal disease 1,2 . The success of kidney transplantation in the HIV population is principally based on the control of HIV replication and the reduction of the host immune response 3 .…”

Section: Introductionmentioning

confidence: 99%

Role of Maraviroc in minimizing the risk of graft rejection in HIV‐infected kidney transplant recipients

Guaraldi¹,

Fontana

Franceschini³

et al. 2020

Transplant Infectious Dis

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Background Kidney transplantation in HIV‐infected patients is characterized by a concerning high rate of allograft rejections. The etiological mechanisms leading to this increased immunoreactivity are still unknown. Maraviroc is a new antiretroviral agent that has been associated with immunomodulatory proprieties; therefore, its use may be a promising strategy to minimize the rate of rejections in HIV‐infected kidney transplant (KT) recipients. Methods We conducted a retrospective study in our cohort of HIV‐KT recipients with the aim to explore the effects of maraviroc in reducing the risk of graft rejection. Results Twenty‐two HIV‐infected KT recipients predominantly of Caucasian origin (86%) and with a median age of 49 (IQR, 51.9‐42.2) years were evaluated. Ten HIV‐infected patients were treated with maraviroc and 12 with a maraviroc‐free antiretroviral regimen. After a median follow‐up of 3.01 years, half of the maraviroc‐treated patients (n = 5) developed seven episodes of graft rejection, most of them were T cell–mediated rejections (85.7%). Five episodes were recorded in the maraviroc‐free group. The difference in the rate of graft rejections was not statistically significant (P = .23). Conclusions The administration of maraviroc was ineffective in preventing graft rejections in our cohort of patients.

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“…Although these drugs usually undergo several clinical trials before they are declared safe, several reports have indicated that they could possess nephrotoxic properties [4]. The kidney plays a major role in the excretion of antiretroviral drugs and this makes it vulnerable to various types of injuries from some of these agents including Acute Kidney Injury (AKI), tubulopathies, Chronic Kidney Disease (CKD) and end stage renal disease requiring renal replacement therapy [5]. Antiretroviral therapy can contribute to renal dysfunction directly by inducing acute tubular necrosis, acute interstitial nephritis, crystal nephropathy, and renal tubular disorders or indirectly via drug interactions.…”

Section: Introductionmentioning

confidence: 99%

“…Antiretroviral therapy can contribute to renal dysfunction directly by inducing acute tubular necrosis, acute interstitial nephritis, crystal nephropathy, and renal tubular disorders or indirectly via drug interactions. [5] Chronic kidney disease should be diagnosed in its early stages through routine screening and careful attention to changes in glomerular filtration rate or creatinine clearance [6]. It is also important that patients with Chronic Kidney Disease (CKD) are not denied the best combi- nations, especially since most drugs can be adjusted based on the estimated glomerular filtration rate [7].…”

Section: Introductionmentioning

confidence: 99%

Untitled

2020

IJCMCR

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Background: Patients infected with Human Immunodeficiency Virus (HIV) live longer while receiving combination therapies of Highly Active Anti-Retroviral Therapy (HAART). However, kidney diseases have emerged as significant causes of morbidity and mortality among these patients. If patients are not monitored, renal complications may develop and a poor prognosis could result into severe kidney damage. Thisvstudy therefore, investigated the effect of the various combination therapies given to the patients' vis a vie their estimated glomerular filtration rate. Methodology: This crosssectional study recruited 200 study participants who were receiving HIV healthcare services from St Daniel Comboni Hospital Kyamuhunga in Bushenyi district. Blood samples were obtained for the analysis of creatinine levels done on a Reflotron® chemistry analyser. Estimated Glomerular Filtration Rate (eGFR) was computed using an online calculator that followed the MDRD (modification of Diet in Renal Disease) equation. Other socio demographic data were obtained from participants along with their drug combination therapies. Results: Of the 200 study participants, 109 were female. Most of them were between the ages of 19-49 years. There were 4 drug combination therapies that were investigated in this study; (AZT+3TC+EFV-12.5%, AZT+3TC+NVP-21.5%, TDF+3TC+EFV-43.5%, TDF+3TC+NVP-22.5%) and upon linear regression analysis, none of them had a statistically significant relationship with the eGFR although they seemed to have both a positive and negative correlation with the latter. Conclusion: Combination therapies given to HIV/AIDS patients are safe to use and do not pose as such a significant health risk to kidney damage unless they are poorly prescribed and the patients are not routinely monitored.

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Kidney Disease in HIV Infection

Cited by 42 publications

References 120 publications

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

Role of Maraviroc in minimizing the risk of graft rejection in HIV‐infected kidney transplant recipients

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