Updated HIV Guidelines Urge Caution in Tenofovir Use

Tenofovir drug can lead to moderate kidney damage in some patients.
Tenofovir drug can lead to moderate kidney damage in some patients.

Updated guidelines from the Infectious Diseases Society of America (IDSA) state that HIV-infected patients with reduced kidney function benefit from antiretroviral therapy (ART), but tenofovir should be avoided.

The guidelines, published online in Clinical Infectious Diseases, revise those released in 2005. Large studies conducted since then suggest that tenofovir, an antiretroviral agent, can lead to moderate kidney damage in some patients, according to an IDSA press release. The guidelines also recommend kidney transplantation as a viable option in HIV-infected patients who kidneys are failing.

Gregory Lucas, MD, co-chair of the panel that developed the guidelines, noted in the press release that patients with a glomerular filtration rate below 60 mL/min/1.73 m2 “should likely not be prescribed tenofovir, adding that “there are many different ART options, so why risk toxicity?”

Additionally, patients on tenofovir should be taken off the drug if there is a clinically significant decline in kidney function and placed on another therapy, he said.

Kidney disease is common in HIV-infected individuals because of the virus itself, some antiretroviral agents and other drugs, and a high prevalence of traditional kidney disease risk factors and other conditions, such as hypertension, diabetes, and co-infection with hepatitis C virus, said Dr. Lucas, an associate professor at Johns Hopkins University in Baltimore. HIV-infected individuals with kidney problems are at risk for end-stage renal disease, Dr. Lucas said.

“Research shows that HIV patients who have clinically decreased kidney function are less likely to be prescribed ART, probably because physicians and other healthcare providers are concerned that many of these medications are cleared by the kidneys and don't want to cause further harm,” Dr. Lucas said in the release. “But the outlook for HIV patients with kidney disease is much better now that we have numerous effective treatments for HIV, many of which are not cleared by the kidneys.”

The guidelines note that initial research suggests that HIV patients who have kidney transplants are as likely to survive and to maintain a functioning allograft as kidney transplant recipients not infected with HIV.

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