More people who are HIV-1 positive are living longer and better managing comorbidities—especially those associated with kidney disease. This becomes critical since the medications patients with HIV must take can be nephrotoxic with long-term use. Researchers from the AIDS Clinical Center, National Center for Global Health and Medicine, in Tokyo, Japan note that Asian patients may be at higher risk because of their generally smaller body weight and metabolism differences, compared with whites and blacks.
Few studies in Asia had assessed the prevalence and factors associated with chronic kidney disease (CKD) and end-stage renal disease (ERSD) in patients with HIV-1, the researchers say, so they conducted the first, to their knowledge, with a cross-sectional study of 1,990 patients.
One third of the patients were aged ≥ 50 years. Nearly all (94%) had HIV-load < 50 copies/mL. The median time from diagnosis to study enrollment was 9.1 years; the median duration of antiretroviral therapy (ART) was 7.35 years. Of the study patients, 256 (13%) had chronic kidney disease and 9 (0.5%) had ESRD. It is noteworthy, the researchers say, that 5 of those 9 developed ESRD long after the diagnosis of HIV infection and that the age of the ESRD patients varied from 30s to 60s.
The incidence of CKD rose from 18.6% among those aged 50-59 years to 47% for those aged > 70 years. Heavier body weight, diabetes, hypertension, and longer duration of ART also were associated with CKD. Duration of exposure to tenofovir disoproxil fumarate (TDF), however, was not associated with CKD. Of all the patients, 61% had a history of TDF use. At the time of the study, 774 patients were taking TDF; 69 in the group with CKD and 705 in the group without CKD.
Tenofovir disoproxil fumarate nephrotoxicity had been well publicized by 2016, when the data were collected for this study, the researchers note, which is why they used “duration of TDF exposure” in their logistic regression model. Tenofovir disoproxil fumarate may have been discontinued early on for the patients at risk for CKD in their study cohort. However, they note that while TDF will be replaced with its prodrug tenofovir alafenamide, other antiretroviral drugs that inhibit excretion of creatinine in the renal proximal tubules and increase serum creatinine value, such as dolutegravir, cobicistat, rilpivirine, raltegravir, and ritonavir, will still be widely used.
Nishijima T, Kawasaki Y, Mutoh Y, et al. Sci Rep. 2017;7(14565) doi:10.1038/s41598-017-15214-x