Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: the D:A:D study
Lene Ryom,Amanda Mocroft,Ole Kirk,Ole Kirk,Signe Westring Worm,David Kamara,Peter Reiss,Michael W. Ross,Christoph A Fux,Philippe Morlat,Olivier Moranne,Colette Smith,Jens D Lundgren,Jens D Lundgren +13 more
TLDR
In this article, the authors used Poisson regression to identify predictors and eGFR-related discontinuations of antiretroviral agents (ARVs) associated with chronic renal impairment, but the extent of such adverse events among human immunodeficiency virus (HIV)-positive persons with initially normal renal function is unknown.Abstract:
BACKGROUND: Several antiretroviral agents (ARVs) are associated with chronic renal impairment, but the extent of such adverse events among human immunodeficiency virus (HIV)-positive persons with initially normal renal function is unknown. METHODS: D:A:D study participants with an estimated glomerular filtration rate (eGFR) of ≥ 90 mL/min after 1 January 2004 were followed until they had a confirmed eGFR of ≤ 70 mL/min (the threshold below which we hypothesized that renal interventions may begin to occur) or ≤ 60 mL/min (a value indicative of moderately severe chronic kidney disease [CKD]) or until the last eGFR measurement during follow-up. An eGFR was considered confirmed if it was detected at 2 consecutive measurements ≥ 3 months apart. Predictors and eGFR-related ARV discontinuations were identified using Poisson regression. RESULTS: Of 22 603 persons, 468 (2.1%) experienced a confirmed eGFR of ≤ 70 mL/min (incidence rate, 4.78 cases/1000 person-years of follow-up [95% confidence interval {CI}, 4.35-5.22]) and 131 (0.6%) experienced CKD (incidence rate, 1.33 cases/1000 person-years of follow-up [95% CI, 1.10-1.56]) during a median follow-up duration of 4.5 years (interquartile range [IQR], 2.7-6.1 years). A current eGFR of 60-70 mL/min caused significantly higher rates of discontinuation of tenofovir (adjusted incidence rate ratio [aIRR], 1.72 [95% CI, 1.38-2.14]) but not other ARVs compared with a current eGFR of ≥ 90 mL/min. Cumulative tenofovir use (aIRR, 1.18/year [95% CI, 1.12-1.25]) and ritonavir-boosted atazanavir use (aIRR, 1.19/year [95% CI, 1.09-1.32]) were independent predictors of a confirmed eGFR of ≤ 70 but were not significant predictors of CKD whereas ritonavir-boosted lopinavir use was a significant predictor for both end points (aIRR, 1.11/year [95% CI, 1.05-1.17] and 1.22/year [95% CI, 1.16-1.28], respectively). Associations were unaffected by censoring for concomitant ARV use but diminished after discontinuation of these ARVs. CONCLUSIONS: Tenofovir, ritonavir-boosted atazanavir, and ritonavir-boosted lopinavir use were independent predictors of chronic renal impairment in HIV-positive persons without preexisting renal impairment. Increased tenofovir discontinuation rates with decreasing eGFR may have prevented further deteriorations. After discontinuation, the ARV-associated incidence rates decreased.read more
Citations
More filters
Journal ArticleDOI
Initiation of antiretroviral therapy in early asymptomatic HIV infection
Sean Emery,Shweta Sharma,Gerd Fätkenheuer,Josep M. Llibre,Jean-Michel Moli,Paula Munderi,Robin Wood,Karin L. Klingman,Simon Collins,H. Clifford Lane,Andrew N. Phil,James D. Neaton +11 more
TL;DR: The initiation of antiretroviral therapy in HIV-positive adults with a CD4+ count of more than 500 cells per cubic millimeter provided net benefits over starting such therapy in patients after the CD4+, but the risks of unscheduled hospital admissions were similar in the two groups.
Journal ArticleDOI
The end of AIDS: HIV infection as a chronic disease
TL;DR: Concerns are growing that the multimorbidity associated with HIV disease could affect healthy ageing and overwhelm some health-care systems, particularly those in resource-limited regions that have yet to develop a chronic care model fully.
Journal ArticleDOI
Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected With HIV: 2014 Update by the HIV Medicine Association of the Infectious Diseases Society of America
Gregory M. Lucas,Michael W. Ross,Peter G. Stock,Michael G. Shlipak,Christina M. Wyatt,Samir K. Gupta,Mohamed G. Atta,Kara Wools-Kaloustian,Paul A. Pham,Leslie A. Bruggeman,Jeffrey L. Lennox,Patricio E. Ray,Robert C. Kalayjian +12 more
TL;DR: IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
Journal ArticleDOI
HIV infection and cardiovascular disease.
Lars G. Hemkens,Heiner C. Bucher +1 more
TL;DR: Timely initiation of ART with consequent viral suppression is likely to reduce CVD events and to offset potential side effects from ART-induced metabolic changes, and reduction in smoking in HIV-infected individuals is a public health priority.
Journal ArticleDOI
An updated prediction model of the global risk of cardiovascular disease in HIV-positive persons: The Data-collection on Adverse Effects of Anti-HIV Drugs (D:A:D) study
Nina Friis-Møller,Lene Ryom,Colette Smith,Rainer Weber,Peter Reiss,François Dabis,Stéphane De Wit,Antonella d'Arminio Monforte,Ole Kirk,Eric Fontas,Caroline A. Sabin,Andrew N. Phillips,Jens D Lundgren,Mathew M.G. Law +13 more
TL;DR: An updated, easily recalibrated, global CVD-risk equation tailored to HIV-positive persons was developed using routinely collected CVD risk parameters and incorporating markers on immune function (CD4 lymphocyte count), and exposure to antiretroviral therapies.
References
More filters
Journal ArticleDOI
Prediction of Creatinine Clearance from Serum Creatinine
Donald W. Cockcroft,M H Gault +1 more
TL;DR: A formula has been developed to predict Creatinine clearance from serum creatinine (Scr) in adult males: Ccr = (140 – age) (wt kg)/72 × Scr (mg/100ml) (15% less i).
Journal Article
K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification
Andrew S. Levey,Josef Coresh,Kline Bolton,Bruce Culleton,Kathy Schiro Harvey,T. Alp Ikizler,Cynda Ann Johnson,Annamaria T. Kausz,Paul L. Kimmel,John W. Kusek,Adeera Levin,Kenneth L. Minaker,Robert Nelson,Helmut G. Rennke,Michael Steffes,Beth Witten,Ronald J. Hogg,Susan Furth,Kevin V. Lemley,Ronald J. Portman,George Schwartz,Joseph Lau,Ethan M Balk,Ronald D. Perrone,Tauqeer Karim,Lara Rayan,Inas Al-Massry,Priscilla Chew,Brad C. Astor,Deirdre De Vine,Garabed Eknoyan,Nathan W. Levin,Sally Burrows-Hudson,William F. Keane,Alan S. Kliger,Derrick Latos,Donna Mapes,Edith Oberley,Kerry Willis,George R. Bailie,Gavin J. Becker,Jerrilynn Burrowes,David Churchill,Allan J. Collins,William Couser,Dick DeZeeuw,Alan Garber,Thomas Golper,Frank A. Gotch,Antonio M. Gotto,Joel W. Greer,Richard H. Grimm,Ramon G. Hannah,Jaime Herrera Acosta,Ronald J. Hogg,Lawrence G. Hunsicker,Michael J. Klag,Saulo Klahr,Caya Lewis,Edmund G. Lowrie,Arthur J. Matas,Sally McCulloch,Maureen Michael,Joseph V. Nally,John M. Newmann,Allen R. Nissenson,Keith Norris,William F. Owen,Thakor G. Patel,Glenda Payne,Rosa A. Rivera-Mizzoni,David A. Smith,Robert A. Star,Theodore Steinman,Fernando Valderrábano,John Walls,Jean Pierre Wauters,Nanette Wenger,Josephine P. Briggs +78 more
TL;DR: In the early 1990s, the National Kidney Foundation (K/DOQI) developed a set of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of kidney disease.
Journal ArticleDOI
National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification
Andrew S. Levey,Josef Coresh,Ethan M Balk,Annamaria T. Kausz,Adeera Levin,Michael W. Steffes,Ronald J. Hogg,Ronald D. Perrone,Joseph Lau,Garabed Eknoyan +9 more
TL;DR: The goal is to disseminate the simple definition and five-stage classification system of Chronic kidney disease, to summarize the major recommendations on early detection of chronic kidney disease in adults, and to consider some of the issues associated with these recommendations.
Journal ArticleDOI
HLA-B*5701 Screening for Hypersensitivity to Abacavir
Simon Mallal,Elizabeth J. Phillips,Giampiero Carosi,Jean-Michel Molina,Cassy Workman,Janez Tomazic,Eva Jägel-Guedes,Sorin Rugină,Oleg Kozyrev,Juan Flores Cid,Phillip Hay,David Nolan,Sara Hughes,Arlene R Hughes,Susanna Ryan,Nicholas Fitch,D. Thorborn,Alastair Benbow +17 more
TL;DR: HLA-B*5701 screening reduced the risk of hypersensitivity reaction to abacavir and showed that a pharmacogenetic test can be used to prevent a specific toxic effect of a drug.