1. Renal function in patients with HIV starting therapy with tenofovir and either efavirenz, lopinavir or atazanavir
- Author
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Jim, Young, Juliane, Schäfer, Christoph A, Fux, Hansjakob, Furrer, Enos, Bernasconi, Pietro, Vernazza, Alexandra, Calmy, Matthias, Cavassini, Rainer, Weber, Manuel, Battegay, Heiner C, Bucher, S, Yerly, University of Zurich, and Young, Jim
- Subjects
Cyclopropanes ,Male ,Ritonavir/adverse effects ,Pyridines ,Kidney/drug effects/physiopathology ,HIV Infections ,Pharmacology ,urologic and male genital diseases ,Kidney ,Glomerular Filtration Rate/drug effects ,HIV Protease Inhibitors/administration & dosage/adverse effects ,Lopinavir ,10234 Clinic for Infectious Diseases ,chemistry.chemical_compound ,immune system diseases ,Immunology and Allergy ,Organophosphonates/adverse effects ,Lopinavir/adverse effects ,Reverse Transcriptase Inhibitors/administration & dosage/adverse effects ,ddc:616 ,Reverse-transcriptase inhibitor ,Drug Therapy, Combination/adverse effects/methods ,virus diseases ,Middle Aged ,Infectious Diseases ,Treatment Outcome ,Alkynes ,2723 Immunology and Allergy ,Reverse Transcriptase Inhibitors ,Drug Therapy, Combination ,Female ,Oligopeptides ,medicine.drug ,Glomerular Filtration Rate ,Adult ,medicine.medical_specialty ,Efavirenz ,Immunology ,Atazanavir Sulfate ,Urology ,HIV Infections/drug therapy ,Organophosphonates ,Renal function ,610 Medicine & health ,Acquired immunodeficiency syndrome (AIDS) ,medicine ,Adenine/adverse effects/analogs & derivatives ,Humans ,Tenofovir ,Pyridines/adverse effects ,2403 Immunology ,Ritonavir ,business.industry ,Adenine ,Benzoxazines/adverse effects ,2725 Infectious Diseases ,HIV Protease Inhibitors ,medicine.disease ,Atazanavir ,Benzoxazines ,chemistry ,business ,Oligopeptides/adverse effects - Abstract
Background: Tenofovir is associated with reduced renal function, but it is not clear whether there is a greater decline in renal function when tenofovir is co-administered with a boosted protease inhibitor rather than with a nonnucleoside reverse transcriptase inhibitor (NNRTI). Methods: We calculated the estimated glomerular filtration rate (eGFR) for patients in the Swiss HIV Cohort Study. We estimated the difference in eGFR over time between first therapies containing tenofovir and either the NNRTI efavirenz or the protease inhibitors lopinavir (LPV/r) or atazanavir (ATV/r), both boosted with ritonavir. Results: Patients on a first therapy of tenofovir co-administered with efavirenz (n ¼484), LPV/r (n ¼269) and ATV/r (n ¼187) were followed for a median of 1.7, 1.2 and 1.3 years, respectively. Relative to tenofovir and efavirenz, the estimated difference in eGFR for tenofovir and LPV/r was � 2.6ml/min per 1.73m 2 [95% confidence interval (CI) � 7.3 to 2.2) during the first 6 months of therapy, then followed by a difference of 0.0ml/min per 1.73m 2 (95% CI � 1.1 to 1.1) for each additional 6 months of therapy. Relative to tenofovir and efavirenz, the estimated difference in eGFR fortenofovirandATV/r was � 7.6ml/min per 1.73m 2 (95% CI � 11.8to � 3.4) duringthe first 6 months of therapy, then followed by a difference of � 0.5ml/min per 1.73m 2 (95% CI � 1.6 to 0.7) for each additional 6 months of therapy. Conclusion: Tenofovir with either boosted protease inhibitor leads to a greater initial decline in eGFR than tenofovir with efavirenz; this decline may be worse with ATV/r than with LPV/r. 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2012, 26:567‐575
- Published
- 2012