Renal adverse drug reactions

Abstract

Purpose of review Chronic kidney disease (CKD) is common in people living with HIV (PLWH) and is related to a multitude of factors. The aim of this review is to provide an overview of the most recent evidence of renal adverse effects of antiretroviral drugs, predictors of CKD risk and areas for future research. Recent findingsAdvancing age, cardiometabolic risk factors and adverse effects of antiretroviral drugs contribute to the higher prevalence of CKD in PLWH. Genetic factors and baseline clinical CKD risk are strongly correlated to risk of incident CKD, although it is unclear to what extent gene polymorphisms explain renal adverse effects related to tenofovir disoproxil fumarate (TDF). Switching from TDF to tenofovir alafenamide (TAF) in people with baseline renal dysfunction improves renal parameters; however, the long-term safety and benefit of TAF in individuals at low risk of CKD is an area of ongoing research.

Increased kidney disease mortality among people with AIDS versus the general population: a population-based cohort study in Italy, 2006–2018

“…Indeed, in the stratified analyses, we found particularly elevated SMRs among 'early testers' who, conversely, almost certainly underwent HAART and could have been affected by the nephrotoxic effects of antiviral treatments. 26 Our findings reflect the increased incidence of kidney diseases among HIV-infected people compared with non-HIV-infected. 17 An observational nationwide French study reported a 1.5-fold higher prevalence of kidney diseases among hospitalised people with HIV than in the general population, with an increasing trend over time.…”

“…However, our cohort of PWA mostly consisted of people with a short time interval between the first HIV-positive test and AIDS diagnosis (ie, late testers) who, probably, had never been treated with HAART. Indeed, in the stratified analyses, we found particularly elevated SMRs among ‘early testers’ who, conversely, almost certainly underwent HAART and could have been affected by the nephrotoxic effects of antiviral treatments 26…”

Integration of High-Throughput Imaging and Multiparametric Metabolic Profiling Reveals a Mitochondrial Mechanism of Tenofovir Toxicity

“…Finally, a newer formation of tenofovir (tenofovir alafenamide) might be less nephrotoxic than TDF in the short term, although longer term benefits are unclear, and the active ingredient is the same. 49 …”

Cell and Tissue Specific Metabolism of Nucleoside and Nucleotide Drugs: Case Studies and Implications for Precision Medicine

“…Clinical use of TDF has generally been well tolerated, however TDF regimens are associated with renal adverse events and bone abnormalities (Nelson et al, 2007). The renal events linked to TDF therapy include acute kidney injury, proximal tubular dysfunction, and chronic kidney disease (Hughes, 2021). Concomitant risk factors for renal events linked to TDF therapy have been identified, and it is recommended that clinicians monitor such patients closely.…”