June 22, 2010

HIV-Related Kidney Troubles Linked to Age, Race, CD4 Count and Tenofovir

A new study has found that the overall rate of kidney dysfunction was only 3 percent in a group of HIV-positive military personnel, but several factors including older age, African-American race and the use of tenofovir (found in Viread, Truvada and Atripla) increased the risk of developing the condition. The study was published in the June issue of AIDS Patient Care and STDs.

The introduction of potent antiretroviral (ARV) combination therapy in the late 1990s caused a precipitous plunge in the rate of opportunistic infections (OI) and death in people with HIV. Those reductions in OI rates have been sustained, yet during the last decade researchers have noted a rise in diseases not typically associated with HIV, including cardiovascular, liver and kidney diseases.

Before combination ARV treatment was introduced, most HIV-associated chronic kidney problems were tied to low CD4 counts and African-American race. In recent years, other factors, including older age, co-occurring conditions—such as diabetes and high blood pressure, and uncontrolled HIV reproduction—have all begun to be associated with kidney problems.

To assess the prevalence of kidney disease and the factors associated with it in the modern HIV treatment era, Nancy Crum-Cianflone, MD, from the HIV clinic at the Naval Medical Center San Diego, and her colleagues assessed the medical records of 717 HIV-positive military personnel being cared for at naval clinics in San Diego or Bethesda, Maryland.

Most of the study participants were male, and roughly 40 percent were African American. The vast majority, 77 percent, were taking ARV therapy. Of those, 44 percent were on a regimen that included tenofovir. Kidney function was assessed by measuring the estimated glomerular filtration rate (eGFR). An eGFR rate of 60 or greater was considered functional, and an eGFR of less than 60 was considered dysfunctional—the lower the number, the poorer the kidney function.

Crum and her colleagues found several factors associated with kidney dysfunction. These included older age, African American race and tenofovir use. Having a low CD4 nadir, which refers to a person’s lowest ever CD4 count, was also associated with a greater risk of kidney dysfunction. Among tenofovir users, African-American race, female gender and a lower CD4 nadir were all associated with a drop in eGFR.

“Further studies are needed to determine if differential guidelines on kidney function monitoring in select HIV populations would be beneficial,” conclude the authors.

Search: Kidney, race, tenofovir, Viread, Truvada, Atripla, Nancy Crum Cianflone, renal, GFR, African American, liver

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Previous Comments:

MusicMan, NYC Metro, 2010-06-24 10:07:10
After 5 years on a cocktail which included Viread, I recently had some major kidney problems that hospitalized me for 4 days A stent was placed in one of my ureters to clear several medium-large stones. Analysis indicated Viread as the culprit. Both Viread AND Reyataz are processed thru the kidneys, so if on these meds, make sure your Docs are watching kidney functions carefully, especially Creatinine. Most other meds are processed through the liver, so there are options for many of us.

DrTeddy, Sann Francisco, 2010-06-23 16:58:52
Chronic inflammatory disease related to HIV is causing increased morbidity in our HIV + population especially African Americans as most of them also have aging, Hypertension, Diabetes, Connective Tissue diseases. The addition of effects from Tenofovir could be the tipping point for many on their kidney health and unless we screen early all these high risk patients and find a way to retard the process Atripla's popularity might pass away like that of Abacavir.

Lovinglife, Tampa, 2010-06-23 12:42:10
I am a white 44 year old female who has been positive for over 25 years. I take Viread and have been diagnosed with kidney damage. I have been on meds since the days of AZT so there are many factors in my history that might contribute to this diagnosis. Becuase I am resistant to many of the medications I must continue to take Viread and other HIV meds. The benefits of continuning my medications, for me, outweigh the consequesnces. I am alive and for that I am grateful.