title: Renal tubular disease in the era of combination antiretroviral therapy.
abstract: OBJECTIVE
  To describe the spectrum of renal tubular disease (RTD) in HIV-positive patients and its association with exposure to antiretroviral therapy (ART).
  
  
  METHODS
  Review of 265 consecutive renal biopsies from HIV-positive patients attending eight clinics in the United Kingdom between 2000 and 2012.
  
  
  METHODS
  We described the clinical characteristics of patients with RTD and compared current/recent exposure (at the time of, or up to 3 months prior to the date of biopsy) to potentially nephrotoxic ART [tenofovir (TDF), atazanavir (ATV), indinavir (IDV) and lopinavir/ritonavir (LPV/r)]. We also analysed the incidence of RTD in the UK CHIC cohort. Kruskall-Wallis, analysis of variance and Fisher's exact tests were used to evaluate between-group differences.
  
  
  RESULTS
  Of the 60 RTD cases, 54 (90%) were included in the analyses. RTD comprised of three distinct patterns: acute tubular injury (ATI, n = 22), tubulo-interstitial nephritis (TIN, n = 20) and interstitial fibrosis and tubular atrophy (IFTA, n = 12). Compared with TIN and IFTA, ATI cases were less likely to be of black ethnicity (10 vs. 42-55%; P = 0.006), more likely to be on ART (100 vs. 55-68%; P = 0.001), with HIV-RNA below 200 copies/ml (100 vs. 54-58%; P < 0.001), and more likely to have current/recent exposure to TDF (P < 0.001). We did not find evidence for an association between exposure to TDF, ATV/r or LPV/r and either TIN or IFTA.
  
  
  CONCLUSIONS
  RTD was present in approximately 20% of renal biopsies and comprised three distinct injury patterns with considerable clinical overlap. ATI was associated with TDF exposure, although the overall incidence of biopsy-defined ATI was low.
authors.affiliation: aKing's College Hospital NHS Foundation Trust and King's College London bRoyal Free Hospital NHS Foundation Trust and University College London cChelsea and Westminster NHS Foundation Trust, Imperial College Healthcare NHS Trust and Imperial College London dGuy's and St Thomas' NHS Foundation Trust, London eBrighton and Sussex University Hospitals, Brighton, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hamzah
authors.forename: John W
authors.initials: JW
authors.lastname: Booth
authors.forename: Sophie
authors.initials: S
authors.lastname: Jose
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McAdoo
authors.forename: Emil A
authors.initials: EA
authors.lastname: Kumar
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Donnell
authors.forename: Rachel
authors.initials: R
authors.lastname: Hilton
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Deborah I
authors.initials: DI
authors.lastname: Williams
authors.forename: Rachael
authors.initials: R
authors.lastname: Jones
authors.forename: Frank A
authors.initials: FA
authors.lastname: Post
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000139:chemically induced* / Q000453:epidemiology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D001706:Biopsy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006651:Histocytochemistry; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents