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Renal function in patients with HIV starting therapy with tenofovir and either efavirenz, lopinavir or atazanavir

Young, Jima; Schäfer, Julianea; Fux, Christoph A.b; Furrer, Hansjakobb; Bernasconi, Enosc; Vernazza, Pietrod; Calmy, Alexandrae; Cavassini, Matthiasf; Weber, Rainerg; Battegay, Manuelh; Bucher, Heiner C.a,h; the Swiss HIV Cohort Study

doi: 10.1097/QAD.0b013e32834f337c
Clinical Science

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 = 484), LPV/r (n = 269) and ATV/r (n = 187) 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 −2.6 ml/min per 1.73 m2 [95% confidence interval (CI) −7.3 to 2.2) during the first 6 months of therapy, then followed by a difference of 0.0 ml/min per 1.73 m2 (95% CI −1.1 to 1.1) for each additional 6 months of therapy. Relative to tenofovir and efavirenz, the estimated difference in eGFR for tenofovir and ATV/r was −7.6 ml/min per 1.73 m2 (95% CI −11.8 to −3.4) during the first 6 months of therapy, then followed by a difference of −0.5 ml/min per 1.73 m2 (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.

aBasel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel

bDivision of Infectious Diseases, University Hospital Bern and University of Bern, Bern

cRegional Hospital of Lugano, Lugano

dDivision of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen

eDivision of Infectious Diseases, University Hospital Geneva, Geneva

fDivision of Infectious Diseases, University Hospital Lausanne, Lausanne

gDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich

hDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.

Correspondence to Jim Young, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, CH-4031 Basel, Switzerland. Tel: +41 61 265 3100; fax: +41 61 265 3109; e-mail: jyoung@uhbs.ch

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Received 22 September, 2011

Revised 6 November, 2011

Accepted 14 November, 2011

© 2012 Lippincott Williams & Wilkins, Inc.