Incidence of renal toxicity in HIV-infected, antiretroviral-naïve patients starting tenofovir/emtricitabine associated with efavirenz, atazanavir/ritonavir, or lopinavir/ritonavir

Scand J Infect Dis. 2013 Feb;45(2):147-54. doi: 10.3109/00365548.2012.712213. Epub 2012 Sep 19.

Abstract

Objectives: 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.

MeSH terms

  • Adenine / administration & dosage
  • Adenine / adverse effects
  • Adenine / analogs & derivatives
  • Adult
  • Atazanavir Sulfate
  • Benzoxazines / administration & dosage
  • Benzoxazines / adverse effects
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / adverse effects
  • Deoxycytidine / analogs & derivatives
  • Emtricitabine
  • Female
  • Glomerular Filtration Rate / drug effects
  • Glycosuria / chemically induced
  • Glycosuria / virology
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • HIV Protease Inhibitors / administration & dosage
  • HIV Protease Inhibitors / adverse effects*
  • Humans
  • Kidney Diseases / blood
  • Kidney Diseases / chemically induced*
  • Lopinavir / administration & dosage
  • Lopinavir / adverse effects
  • Male
  • Middle Aged
  • Oligopeptides / administration & dosage
  • Oligopeptides / adverse effects
  • Organophosphonates / administration & dosage
  • Organophosphonates / adverse effects
  • Proteinuria / chemically induced
  • Proteinuria / virology
  • Pyridines / administration & dosage
  • Pyridines / adverse effects
  • Retrospective Studies
  • Ritonavir / administration & dosage
  • Ritonavir / adverse effects
  • Tenofovir

Substances

  • Benzoxazines
  • HIV Protease Inhibitors
  • Oligopeptides
  • Organophosphonates
  • Pyridines
  • Deoxycytidine
  • Lopinavir
  • Atazanavir Sulfate
  • Tenofovir
  • Emtricitabine
  • Adenine
  • efavirenz
  • Ritonavir