TY - JOUR
T1 - 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
AU - Mocroft, Amanda
AU - Lundgren, Jens D.
AU - Ross, Michael
AU - Fux, Christoph A.
AU - Reiss, Peter
AU - Moranne, Olivier
AU - Morlat, Philippe
AU - Monforte, Antonella d'Arminio
AU - Kirk, Ole
AU - The D:A:D Study Group
AU - Oude Lashof, Astrid
AU - Lowe, Selwyn
AU - van Loo, Inge
AU - Ryom, Lene
PY - 2016/1
Y1 - 2016/1
N2 - 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 In this prospective international cohort study, HIV-positive adult participants (aged >= 16 years) from the D:A:D study (based in Europe, the USA, and Australia) with first eGFR greater than 90 mL/min per 1.73 m(2) were followed from baseline (first eGFR measurement after Jan 1, 2004) until the occurrence of one of the following: chronic kidney disease; last eGFR measurement; Feb 1, 2014; or final visit plus 6 months (whichever occurred first). Chronic kidney disease was defined as confirmed (>3 months apart) eGFR lower than 60 mL/min per 1.73 m(2). The primary outcome was the occurrence of chronic kidney disease. Poisson regression was used to estimate the incidence rate of chronic kidney disease associated with cumulative exposure to tenofovir disoproxil fumarate, ritonavir- boosted atazanavir, ritonavir- boosted lopinavir, other ritonavir- boosted protease inhibitors, or abacavir.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 23905 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], pInterpretation In people with normal renal function, the annual incidence of chronic kidney disease increased for up to 6 years of exposure to tenofovir disoproxil fumarate, ritonavir- boosted atazanavir, or ritonavir- boosted lopinavir therapy. Although the absolute number of new cases of chronic kidney disease was modest, treatment with these antiretrovirals might result in an increasing and cumulative risk of chronic kidney disease. Patients on potentially nephrotoxic antiretrovirals or at high risk of chronic kidney disease should be closely monitored.
AB - 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 In this prospective international cohort study, HIV-positive adult participants (aged >= 16 years) from the D:A:D study (based in Europe, the USA, and Australia) with first eGFR greater than 90 mL/min per 1.73 m(2) were followed from baseline (first eGFR measurement after Jan 1, 2004) until the occurrence of one of the following: chronic kidney disease; last eGFR measurement; Feb 1, 2014; or final visit plus 6 months (whichever occurred first). Chronic kidney disease was defined as confirmed (>3 months apart) eGFR lower than 60 mL/min per 1.73 m(2). The primary outcome was the occurrence of chronic kidney disease. Poisson regression was used to estimate the incidence rate of chronic kidney disease associated with cumulative exposure to tenofovir disoproxil fumarate, ritonavir- boosted atazanavir, ritonavir- boosted lopinavir, other ritonavir- boosted protease inhibitors, or abacavir.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 23905 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], pInterpretation In people with normal renal function, the annual incidence of chronic kidney disease increased for up to 6 years of exposure to tenofovir disoproxil fumarate, ritonavir- boosted atazanavir, or ritonavir- boosted lopinavir therapy. Although the absolute number of new cases of chronic kidney disease was modest, treatment with these antiretrovirals might result in an increasing and cumulative risk of chronic kidney disease. Patients on potentially nephrotoxic antiretrovirals or at high risk of chronic kidney disease should be closely monitored.
KW - TENOFOVIR DISOPROXIL FUMARATE
KW - RENAL-FUNCTION
KW - INFECTED INDIVIDUALS
KW - PROTEASE INHIBITOR
KW - NAIVE PATIENTS
KW - RISK-FACTORS
KW - ASSOCIATION
KW - THERAPY
KW - CREATININE
KW - EFAVIRENZ
U2 - 10.1016/S2352-3018(15)00211-8
DO - 10.1016/S2352-3018(15)00211-8
M3 - Article
SN - 2352-3018
VL - 3
SP - E23-E32
JO - The lancet HIV
JF - The lancet HIV
IS - 1
ER -