title: Renal function in patients with HIV starting therapy with tenofovir and either efavirenz, lopinavir or atazanavir.
abstract: BACKGROUND
  Tenofovir is associated with reduced renal function, but it is not clear whether there is a greater decline in renal function when tenofovir is co-administered with a boosted protease inhibitor rather than with a nonnucleoside reverse transcriptase inhibitor (NNRTI).
  
  
  METHODS
  We calculated the estimated glomerular filtration rate (eGFR) for patients in the Swiss HIV Cohort Study. We estimated the difference in eGFR over time between first therapies containing tenofovir and either the NNRTI efavirenz or the protease inhibitors lopinavir (LPV/r) or atazanavir (ATV/r), both boosted with ritonavir.
  
  
  RESULTS
  Patients on a first therapy of tenofovir co-administered with efavirenz (n  = 484), LPV/r (n = 269) and ATV/r (n =  187) were followed for a median of 1.7, 1.2 and 1.3 years, respectively. Relative to tenofovir and efavirenz, the estimated difference in eGFR for tenofovir and LPV/r was -2.6 ml/min per 1.73 m [95% confidence interval (CI) -7.3 to 2.2) during the first 6 months of therapy, then followed by a difference of 0.0 ml/min per 1.73 m (95% CI -1.1 to 1.1) for each additional 6 months of therapy. Relative to tenofovir and efavirenz, the estimated difference in eGFR for tenofovir and ATV/r was -7.6 ml/min per 1.73 m (95% CI -11.8 to -3.4) during the first 6 months of therapy, then followed by a difference of -0.5 ml/min per 1.73 m (95% CI -1.6 to 0.7) for each additional 6 months of therapy.
  
  
  CONCLUSIONS
  Tenofovir with either boosted protease inhibitor leads to a greater initial decline in eGFR than tenofovir with efavirenz; this decline may be worse with ATV/r than with LPV/r.
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland. jyoung@uhbs.ch
authors.forename: Jim
authors.initials: J
authors.lastname: Young
authors.forename: Juliane
authors.initials: J
authors.lastname: Schäfer
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Fux
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Pietro
authors.initials: P
authors.lastname: Vernazza
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives; D000328:Adult; D000480:Alkynes; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000009:adverse effects; D003521:Cyclopropanes; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D061466:Lopinavir / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects; D063065:Organophosphonates / Q000009:adverse effects; D011725:Pyridines / Q000009:adverse effects; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019438:Ritonavir / Q000009:adverse effects; D000068698:Tenofovir; D016896:Treatment Outcome
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D063065:Organophosphonates; D011725:Pyridines; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D000068698:Tenofovir; D000225:Adenine; C098320:efavirenz; D019438:Ritonavir