Renal function and incidence of chronic kidney disease in HIV patients: a Danish cohort study.
BACKGROUND
Impaired renal function is of major concern in human immunodeficiency virus (HIV)-infected patients.


METHODS
We used a mixed effects linear regression model to determine estimated glomerular filtration rates (eGFRs) in a population-based cohort of incident Danish HIV patients and stratified on baseline eGFR (eGFR(B)) < 90 and ≥ 90 ml/min per 1.73 m(2). Incidence rate ratios (IRRs) for chronic kidney disease (CKD) - 2 consecutive eGFR values < 60 ml/min per 1.73 m(2) measured > 3 months apart - were estimated (time-updated Cox-regression model).


RESULTS
The effect of time with HIV on eGFR was small in both strata (- 0.09 (95% confidence interval (CI) - 0.27, 0.09) and - 0.46 (95% CI - 0.64, - 0.27) ml/min per 1.73 m(2) per y). Treatment with tenofovir and indinavir was associated with lower eGFR in both strata: tenofovir - 2.00 (95% CI - 3.45, - 0.56) and - 1.94 (95% CI - 3.43, - 0.44) ml/min per 1.73 m(2) and indinavir - 2.14 (95% CI - 3.63, - 0.64) and - 3.29 (95% CI - 5.25, - 1.32) ml/min per 1.73 m(2). Nevirapine, atazanavir, and the combination of tenofovir and atazanavir were associated with lower eGFR in patients with eGFR(B) < 90 ml/min per 1.73 m(2). Highly active antiretroviral therapy (HAART) and exposure to tenofovir and atazanavir in combination were associated with CKD in patients with eGFR(B) < 90 ml/min per 1.73 m(2) (adjusted IRRs 6.08 (95% CI 2.76-13.41) and 26.75 (95% CI 9.54-75.05)).


CONCLUSIONS
Tenofovir and indinavir reduce eGFR, while time with HIV only has a modest effect on this parameter. Low eGFR(B) is associated with an increased risk of CKD, especially when receiving HAART regimens containing the combination tenofovir/atazanavir.
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. magnus.rasch@gmail.com
Magnus G
MG
Rasch
Frederik N
FN
Engsig
Bo
B
Feldt-Rasmussen
Ole
O
Kirk
Gitte
G
Kronborg
Court
C
Pedersen
Jan
J
Gerstoft
Niels
N
Obel
D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000069446:Atazanavir Sulfate; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects / Q000627:therapeutic use; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000821:virology*; D000068698:Tenofovir
D019380:Anti-HIV Agents; D009842:Oligopeptides; D063065:Organophosphonates; D011725:Pyridines; D000069446:Atazanavir Sulfate; D000068698:Tenofovir; D000225:Adenine