title: The problem of renal function monitoring in patients treated with the novel antiretroviral drugs.
abstract: Chronic kidney disease (CKD) is currently considered a major comorbidity in patients affected by HIV infection. In addition, new generation antiretroviral drugs that interact with creatinine transporters were recently introduced. Rilpivirine, dolutegravir, and cobicistat, with different mechanisms, inhibit the amount of tubular secretion of creatinine causing a slight increase in serum creatinine levels and consensual eGFRcreat reduction. This will require an unprecedented attention to renal issues, because the new drugs can also be associated to old antiretroviral drugs that may exert renal toxic effects. Owing to the interference of these drugs with creatinine secretion, an alternative way of estimating GFR would be desirable. At the moment, methods of direct GFR measurement have a high impact on the patient, are not readily available, or are not reliable in HIV patients. Consequently, use of classic formulas to estimate GFR is still recommended, considering the apparent reduction of eGFRcreat due to these drugs. Tubular function needs to be carefully monitored with simple tests such as proteinuria, phosphatemia, urinary excretion of phosphate, normoglycemic glycosuria, and excretion of uric acid. More specific and sensitive markers of tubular damage are still not readily available in all clinical labs. HIV patients treated by the novel drugs need to be monitored on a monthly basis for the first 3 months. Subsequent monitoring should be performed on a quarterly basis or guided by comorbidities.
authors.affiliation: Clinic of Infectious Diseases, University Hospital "Policlinico", Bari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Maggi
authors.affiliation: Division of Nephrology, University Hospital "Policlinico", Bari, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Montinaro
authors.affiliation: Infectious Disease and Immunopathology Unit, Department of Clinical Sciences "Luigi Sacco", University of Milano, Milano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rusconi
authors.affiliation: Clinic of Infectious Disease, University Hospital "San Martino", Genova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Biagio
authors.affiliation: Infectious and Tropical Diseases Unit, National Institute for Infectious Disease "L. Spallanzani", Roma, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Bellagamba
authors.affiliation: Infectious Diseases Unit, Hospital "A. Manzoni", Lecco, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonfanti
authors.affiliation: Clinic of Infectious Disease, University Hospital "S. Orsola-Malpighi", Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calza
authors.affiliation: Infectious Disease Unit, University Hospital "Careggi", Firenze, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Corsi
authors.affiliation: Internal Medicine and Clinical Immunology Unit, Hospital "San Giovanni", Roma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montella
authors.affiliation: Clinic of Infectious Disease, University Hospital, Modena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
mesh_terms: D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008991:Monitoring, Physiologic; D051436:Renal Insufficiency, Chronic / Q000209:etiology
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; cobicistat; dolutegravir; kidney; rilpivirine