title: Renal effects of novel antiretroviral drugs.
abstract: Chronic kidney disease (CKD) is a critical comorbidity for patients living with HIV, with an estimated prevalence between 2.4 and 17%. Such patients are increasingly affected by diseases associated with ageing, including cardiovascular disease and CKD, and the prevalence of risk factors such as smoking and dyslipidaemia is increased in this population. Proteinuria is also now recognized as a common finding in individuals living with HIV. While combination antiretroviral (ARV) treatments reduce CKD in the HIV-infected population overall, some ARV drugs have been shown to be nephrotoxic and associated with worsening renal function. Over the last few years, several highly efficacious new ARV agents have been introduced. This brief review will look at the novel agents dolutegravir, raltegravir, elvitegravir, cobicistat, tenofovir alafenamide fumarate and atazanavir, all of which have been licensed relatively recently, and describe issues relevant to renal function, creatinine handling and potential nephrotoxicity. Given the prevalence of CKD, the wide range of possible interactions between HIV, ARV therapy, CKD and its treatments, nephrologists need to be aware of these newer agents and their possible effect on kidneys.
authors.affiliation: Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Du Cane Road, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Milburn
authors.affiliation: HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Jones
authors.affiliation: Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Du Cane Road, London, UK.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Levy
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives; D000409:Alanine; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000069446:Atazanavir Sulfate / Q000009:adverse effects; D000069547:Cobicistat / Q000009:adverse effects; D003404:Creatinine; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006575:Heterocyclic Compounds, 3-Ring / Q000009:adverse effects; D006801:Humans; D010078:Oxazines; D010879:Piperazines; D011507:Proteinuria / Q000139:chemically induced / Q000150:complications; D011728:Pyridones; D015363:Quinolones / Q000009:adverse effects; D000068898:Raltegravir Potassium / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000150:complications / Q000378:metabolism; D000068698:Tenofovir / Q000031:analogs & derivatives; D000099226:Dolutegravir
chemical_list: D000225:Adenine; D000409:Alanine; D019380:Anti-HIV Agents; D000069446:Atazanavir Sulfate; D000069547:Cobicistat; D003404:Creatinine; D006575:Heterocyclic Compounds, 3-Ring; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D015363:Quinolones; D000068898:Raltegravir Potassium; D000068698:Tenofovir; D000099226:Dolutegravir; C509700:elvitegravir; C442442:tenofovir alafenamide
keywords: HIV; acute kidney injury; creatinine; proteinuria