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 language | Undefined/Unknown |
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Pages (from-to) | 1359-1369 |
Number of pages | 11 |
Journal | Journal of Infectious Diseases |
Volume | 207 |
Issue number | 9 |
DOIs | |
Publication status | Published - 2013 |
Externally published | Yes |
Research programs
- EMC MM-04-27-01
- EMC MM-04-28-04