HIV treatment guidelines updated for patients with kidney problems

Updated treatment guidelines from the Infectious Diseases Society of America’s HIV Medicine Association indicate that patients with HIV and decreased kidney function would benefit from antiretroviral therapy, with the exception of tenofovir.

“Research shows HIV patients who have clinically decreased kidney function are less likely to be prescribed ART, probably because physicians and other health care providers are concerned that many of these medications are cleared by the kidneys and don’t want to cause further harm,” Gregory Lucas, MD, co-chair of the guidelines and associate professor at Johns Hopkins Bloomberg School of Medicine, said in a press 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 “Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected with HIV” is an addendum to guidelines released in 2005, and notes that there have been several large-scale studies associating tenofovir (Viread, Gilead Sciences) with moderate kidney damage in patients with HIV. Patients with decreased kidney function should be prescribed one of several alternative medications, if possible.

The guidelines also point to new research that suggests kidney transplantation is a viable treatment option for this patient population. Those data indicate that patients with HIV are as likely to survive and maintain a functioning kidney as transplant recipients without the disease.

The guidelines also recommend physicians monitor kidney function in patients with HIV by estimating glomerular filtration rate (GFR) and kidney damage through urinalysis or urine protein. According to the IDSA, up to 10% of patients with HIV have a GFR of less than 60 mL/min/1.73m2, indicating decreased kidney function. Twice that many may have persistent kidney damage, which is typically identified as proteinuria, with preserved kidney function.

“People with a GFR of less than 60 mL/min/1.73m2 should likely not be prescribed tenofovir — there are many different ART options, so why risk toxicity?” Lucas said in the release. “Also, patients who are on tenofovir should be taken off [the medication] if there is a clinically significant drop in kidney function, and placed on another therapy.”

To read a full copy of the updated guidelines, click here.