Prevalence of chronic kidney disease in older patients with HIV infection on antiretroviral treatment

Background Renal insufficiency may affect up to 10% of HIV patients as a result of HIV-associated nephropathy (HIVAN), a consequence of HIV replication in the kidney, AIDS-related kidney disease or drug treatment. Tenofovir, atazanavir and abacavir are mainly used, and it is important to consider the potential impact of kidney disease on antiretroviral therapy.1 2 The increasing number of older patients with HIV coupled with the prevalence of chronic kidney disease (CKD) in this age group and the side effects of antiretrovirals leads us to select them as an at-risk population for clinical drug monitoring. Purpose Assessment of kidney function in older patients infected by HIV treated with antiretrovirals. Materials and methods Retrospective study (2010) of HIV-infected older patients (≥65 years) followed at the infectious disease unit of the author's hospital to identify those with CKD. Data were obtained from patient clinical files, pharmacy drug database and laboratory test results. CKD is defined as either GFR <60 ml/min/1.73 m2 for ≥3 months or presence of kidney damage (KD) for ≥3 months, with or without decreased GFR, manifest by either pathological abnormalities or markers of KD. Proteinuria (>30 mg/dl) is an early and sensitive marker of KD.3 The Modification of Diet in Renal Disease equation was used to estimate the GFR (eGFR).3 The stages (1–5) of CKD are defined based on the level of kidney function. Results Of 63 patients (48 men) with mean age 70.6 (65–84) and mean serum creatinine 0.99±0.31 mg/dl, 15 were diabetic, 19 had CKD at different levels of kidney function: stage 1=3, stage 2=3, stage 3=11, stage 4=1, stage 5=1. Of this nineteen, 14 were men, mean age 70.9 (65–79), 18 with mean serum creatinine 1.25±0.39 mg/dl and 1 with 10.92 mg/dl on haemodialysis, 12 were being treated with tenofovir, 3 with abacavir and 1 with atazanavir+abacavir. Conclusions A significant number of this population had a decreased eGFR and had CKD probably due to age, HIVAN, but also to the use of tenofovir, abacavir or atazanavir.