Association Between Antiretroviral Exposure and Renal Impairment Among HIV-Positive Persons With Normal Baseline Renal Function: the D:A:D Study(a)

L Ryom, A Mocroft, O Kirk, SW Worm, DA Kamara, P Reiss, M Ross, CA Fux, P Morlat, O Moranne, C Smith, JD Lundgren

Research output: Contribution to journalArticleAcademicpeer-review

268 Citations (Scopus)

Abstract

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 incid 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.
Original languageUndefined/Unknown
Pages (from-to)1359-1369
Number of pages11
JournalJournal of Infectious Diseases
Volume207
Issue number9
DOIs
Publication statusPublished - 2013
Externally publishedYes

Research programs

  • EMC MM-04-27-01
  • EMC MM-04-28-04

Cite this