Common HIV Drug Can Cause Kidney Disease

Horizons in Hemophilia, April 2012

Submitted by the National Hemophilia Foundation

According to a recent study from the University of California at San Francisco (UCSF), tenofovir, one of the more effective and commonly prescribed antiretroviral therapies for HIV/AIDS, is associated with significant and progressive risk of kidney damage and chronic kidney disease. The lead investigator of the study was Rebecca Scherzer, PhD, a researcher and statistician at the San Francisco VA Medical Center (SFVAMC) and UCSF.

Scherzer and her colleagues analyzed the electronic health records of 10,841 HIV-infected veterans who began treatment with antiretroviral therapies between 1997 and 2007. The mean age of the subjects was 46; 98% were men. The researchers found that this use of tenofovir (Viread®) was associated with a higher risk of kidney disease, even in individuals who had no pre-existing risk factors for it. Tenofovir, which comes in pill form, can be taken alone or in combination with other HIV antiretroviral drugs. It is a first-line therapy for patients with HIV, favored for its potency, easy dosing and ability to control viral load.

Investigators found that each year of treatment with tenofovir was associated with a 34% rise in risk for proteinuria, protein in the urine (a key indicator of kidney damage); an 11% risk of a rapid decline in kidney function; and a 33% increased risk of developing chronic kidney disease. These results were independent of other factors, including age and whether the veteran had high blood pressure, diabetes or hepatitis C. After they stopped taking tenofovir, patients remained at elevated risk for kidney complications for six months to one year.
 
The authors reported that these damaging side effects may be irreversible, prompting them to stress the importance of closely observing patients on an ongoing basis. “The best strategy right now is to work with your health care provider to continually monitor for kidney damage,” said coauthor Michael G. Shlipak, MD, MPH, chief of general internal medicine at SFVAMC, and professor of medicine and epidemiology and biostatistics at UCSF. “Early detection is the best way to determine when the risks of tenofovir begin to outweigh the benefits.”

The researchers acknowledge that one of the limitations of the study was a short treatment period and follow-up after patients stopped taking tenofovir. Further research is needed to corroborate their findings.

The study, “Association of Tenofovir Exposure with Kidney Disease Risk in HIV Infection,” was published online by the journal AIDS on February 4, 2012.

Source: UCSF news release dated February 10, 2012