title: Incidence of renal toxicity in HIV-infected, antiretroviral-naïve patients starting tenofovir/emtricitabine associated with efavirenz, atazanavir/ritonavir, or lopinavir/ritonavir.
abstract: OBJECTIVE
  We performed a retrospective cohort study of HIV-infected antiretroviral-naïve patients starting a first antiretroviral therapy with tenofovir/emtricitabine plus efavirenz (EFV), atazanavir/ritonavir (ATV/r), or lopinavir/ritonavir (LPV/r).
  
  
  METHODS
  The incidence of renal impairment or proximal tubular dysfunction was evaluated during a 12-month follow-up. Renal impairment was diagnosed by a reduced estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) formula, and tubular dysfunction was diagnosed when ≥ 2 among proteinuria, glucosuria, hypouricaemia, hypophosphataemia, and hypokalaemia, were identified.
  
  
  RESULTS
  A total of 235 patients were enrolled: 82 taking EFV, 78 ATV/r, and 75 LPV/r. The mean decline in eGFR after the 12-month follow-up was significantly greater in subjects treated with ATV/r (-10.4 ml/min/1.73 m(2)) than in those receiving EFV (- 5.1; p = 0.002) or LPV/r (-4.8; p = 0.003). Similarly, a significantly higher incidence of proximal tubulopathy was observed among ATV/r-treated patients (14.1%) compared with patients receiving EFV (4.9%) or LPV/r (5.3%).
  
  
  CONCLUSIONS
  In our retrospective study, naïve patients receiving tenofovir/emtricitabine and ATV/r for 12 months showed a significantly higher decline in eGFR and a significantly higher incidence of proximal tubulopathy than those receiving tenofovir/emtricitabine plus EFV or LPV/r, even though clinically evident renal toxicity associated with tenofovir-based treatment is a very uncommon event.
authors.affiliation: Department of Internal Medicine, Geriatrics and Nephrologic Diseases, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. leonardo.calza@unibo.it
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calza
authors.forename: Filippo
authors.initials: F
authors.lastname: Trapani
authors.forename: Caterina
authors.initials: C
authors.lastname: Salvadori
authors.forename: Eleonora
authors.initials: E
authors.lastname: Magistrelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Colangeli
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Di Bari
authors.forename: Marco
authors.initials: M
authors.lastname: Borderi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D000328:Adult; D000480:Alkynes; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects; D003521:Cyclopropanes; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D000068679:Emtricitabine; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006029:Glycosuria / Q000139:chemically induced / Q000821:virology; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced*; D061466:Lopinavir / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects; D011507:Proteinuria / Q000139:chemically induced / Q000821:virology; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects; D000068698:Tenofovir
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D063065:Organophosphonates; D011725:Pyridines; D003841:Deoxycytidine; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine; C098320:efavirenz; D019438:Ritonavir