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Optimizing antiretroviral regimens in chronic kidney disease

Research output: Contribution to journalReview articlepeer-review

Lisa Hamzah, Rachael Jones, Frank A. Post

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalCURRENT OPINION IN INFECTIOUS DISEASES
Volume32
Issue number1
DOIs
Published1 Feb 2019

Bibliographical 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: © 2019 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

King's Authors

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.

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