Optimizing antiretroviral regimens in chronic kidney disease

Lisa Hamzah; Rachael Jones; Frank A. Post

doi:10.1097/QCO.0000000000000509

Optimizing antiretroviral regimens in chronic kidney disease

Lisa Hamzah, Rachael Jones, Frank A. Post^*

^*Corresponding author for this work

Inflammation Biology

Research output: Contribution to journal › Review article › peer-review

8 Citations (Scopus)

Abstract

Purpose of reviewTo identify recent data that inform the management of individuals with HIV and chronic kidney disease.Recent findingsSeveral nonnucleoside reverse transcriptase, protease, and integrase strand transfer inhibitors inhibit tubular creatinine secretion resulting in stable reductions in creatinine clearance of 5-20 ml/min in the absence of other manifestations of kidney injury. Progressive renal tubular dysfunction is observed with tenofovir disoproxil fumarate in clinical trials, and more rapid decline in estimated glomerular filtration rate in cohort studies of tenofovir disoproxil fumarate and atazanavir, with stabilization, improvement or recovery of kidney function upon discontinuation. Results from clinical trials of tenofovir alafenamide (TAF) in individuals with chronic kidney disease suggest that TAF is well tolerated in those with mild to moderate renal impairment (creatinine clearance >30 ml/min) but results in very high tenofovir exposures in those on haemodialysis.SummaryStandard antiretroviral regimens remain appropriate for individuals with normal and/or stable, mildly impaired kidney function. In those with chronic kidney disease or progressive decline in estimated glomerular filtration rate, antiretrovirals with nephrotoxic potential should be avoided or discontinued. Although TAF provides a tenofovir formulation for individuals with impaired kidney function, TAF is best avoided in those with severe or end-stage kidney disease.

Original language	English
Pages (from-to)	1-7
Number of pages	7
Journal	CURRENT OPINION IN INFECTIOUS DISEASES
Volume	32
Issue number	1
DOIs	https://doi.org/10.1097/QCO.0000000000000509
Publication status	Published - 1 Feb 2019

Keywords

antiretroviral therapy
chronic kidney disease
HIV
tenofovir
tenofovir alafenamide
tenofovir disoproxil fumarate
treatment

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/QCO.0000000000000509

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title = "Optimizing antiretroviral regimens in chronic kidney disease",

abstract = "Purpose of reviewTo identify recent data that inform the management of individuals with HIV and chronic kidney disease.Recent findingsSeveral nonnucleoside reverse transcriptase, protease, and integrase strand transfer inhibitors inhibit tubular creatinine secretion resulting in stable reductions in creatinine clearance of 5-20 ml/min in the absence of other manifestations of kidney injury. Progressive renal tubular dysfunction is observed with tenofovir disoproxil fumarate in clinical trials, and more rapid decline in estimated glomerular filtration rate in cohort studies of tenofovir disoproxil fumarate and atazanavir, with stabilization, improvement or recovery of kidney function upon discontinuation. Results from clinical trials of tenofovir alafenamide (TAF) in individuals with chronic kidney disease suggest that TAF is well tolerated in those with mild to moderate renal impairment (creatinine clearance >30 ml/min) but results in very high tenofovir exposures in those on haemodialysis.SummaryStandard antiretroviral regimens remain appropriate for individuals with normal and/or stable, mildly impaired kidney function. In those with chronic kidney disease or progressive decline in estimated glomerular filtration rate, antiretrovirals with nephrotoxic potential should be avoided or discontinued. Although TAF provides a tenofovir formulation for individuals with impaired kidney function, TAF is best avoided in those with severe or end-stage kidney disease.",

keywords = "antiretroviral therapy, chronic kidney disease, HIV, tenofovir, tenofovir alafenamide, tenofovir disoproxil fumarate, treatment",

author = "Lisa Hamzah and Rachael Jones and Post, {Frank A.}",

note = "Funding Information: L.H. reports a grant to King?s College Hospital and personal fees from Gilead Sciences. R.J. reports grants to Chelsea and Westminster Hospital NHS Foundation Trust from ViiV Healthcare, Merck and Gilead Sciences, and personal fees from Gilead Sciences, Janssen-Cilag, and ViiV Healthcare. F.A.P. reports grants to King?s College Hospital NHS Foundation Trust from ViiV Healthcare and Gilead Sciences, and personal fees from Gilead Sciences, Janssen- Cilag, GlaxoSmithKline/ViiV Healthcare, and Merck. Publisher Copyright: {\textcopyright} 2019 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",

year = "2019",

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doi = "10.1097/QCO.0000000000000509",

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T1 - Optimizing antiretroviral regimens in chronic kidney disease

AU - Hamzah, Lisa

AU - Jones, Rachael

AU - Post, Frank A.

N1 - Funding Information: L.H. reports a grant to King?s College Hospital and personal fees from Gilead Sciences. R.J. reports grants to Chelsea and Westminster Hospital NHS Foundation Trust from ViiV Healthcare, Merck and Gilead Sciences, and personal fees from Gilead Sciences, Janssen-Cilag, and ViiV Healthcare. F.A.P. reports grants to King?s College Hospital NHS Foundation Trust from ViiV Healthcare and Gilead Sciences, and personal fees from Gilead Sciences, Janssen- Cilag, GlaxoSmithKline/ViiV Healthcare, and Merck. Publisher Copyright: © 2019 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Purpose of reviewTo identify recent data that inform the management of individuals with HIV and chronic kidney disease.Recent findingsSeveral nonnucleoside reverse transcriptase, protease, and integrase strand transfer inhibitors inhibit tubular creatinine secretion resulting in stable reductions in creatinine clearance of 5-20 ml/min in the absence of other manifestations of kidney injury. Progressive renal tubular dysfunction is observed with tenofovir disoproxil fumarate in clinical trials, and more rapid decline in estimated glomerular filtration rate in cohort studies of tenofovir disoproxil fumarate and atazanavir, with stabilization, improvement or recovery of kidney function upon discontinuation. Results from clinical trials of tenofovir alafenamide (TAF) in individuals with chronic kidney disease suggest that TAF is well tolerated in those with mild to moderate renal impairment (creatinine clearance >30 ml/min) but results in very high tenofovir exposures in those on haemodialysis.SummaryStandard antiretroviral regimens remain appropriate for individuals with normal and/or stable, mildly impaired kidney function. In those with chronic kidney disease or progressive decline in estimated glomerular filtration rate, antiretrovirals with nephrotoxic potential should be avoided or discontinued. Although TAF provides a tenofovir formulation for individuals with impaired kidney function, TAF is best avoided in those with severe or end-stage kidney disease.

AB - Purpose of reviewTo identify recent data that inform the management of individuals with HIV and chronic kidney disease.Recent findingsSeveral nonnucleoside reverse transcriptase, protease, and integrase strand transfer inhibitors inhibit tubular creatinine secretion resulting in stable reductions in creatinine clearance of 5-20 ml/min in the absence of other manifestations of kidney injury. Progressive renal tubular dysfunction is observed with tenofovir disoproxil fumarate in clinical trials, and more rapid decline in estimated glomerular filtration rate in cohort studies of tenofovir disoproxil fumarate and atazanavir, with stabilization, improvement or recovery of kidney function upon discontinuation. Results from clinical trials of tenofovir alafenamide (TAF) in individuals with chronic kidney disease suggest that TAF is well tolerated in those with mild to moderate renal impairment (creatinine clearance >30 ml/min) but results in very high tenofovir exposures in those on haemodialysis.SummaryStandard antiretroviral regimens remain appropriate for individuals with normal and/or stable, mildly impaired kidney function. In those with chronic kidney disease or progressive decline in estimated glomerular filtration rate, antiretrovirals with nephrotoxic potential should be avoided or discontinued. Although TAF provides a tenofovir formulation for individuals with impaired kidney function, TAF is best avoided in those with severe or end-stage kidney disease.

KW - antiretroviral therapy

KW - chronic kidney disease

KW - HIV

KW - tenofovir

KW - tenofovir alafenamide

KW - tenofovir disoproxil fumarate

KW - treatment

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U2 - 10.1097/QCO.0000000000000509

DO - 10.1097/QCO.0000000000000509

M3 - Review article

C2 - 30461453

AN - SCOPUS:85059112803

SN - 0951-7375

VL - 32

SP - 1

EP - 7

JO - CURRENT OPINION IN INFECTIOUS DISEASES

JF - CURRENT OPINION IN INFECTIOUS DISEASES

IS - 1

ER -

Optimizing antiretroviral regimens in chronic kidney disease

Abstract

Keywords

UN SDGs

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