Renal adverse drug reactions

Area of Science:

• Nephrology
• Infectious Diseases
• Pharmacology

Background:

• Chronic kidney disease (CKD) is a significant comorbidity in people living with HIV (PLWH).
• Multiple factors contribute to the elevated prevalence of CKD in this population, including aging and cardiometabolic conditions.
• Antiretroviral drugs used in HIV treatment can also have renal adverse effects.

Purpose of the Study:

• To review recent evidence on renal adverse effects of antiretroviral therapy (ART).
• To identify predictors of CKD risk in PLWH.
• To highlight areas for future research in HIV-associated nephropathy.

Main Methods:

• Literature review of recent studies on antiretroviral drugs and kidney function in PLWH.
• Analysis of factors contributing to CKD incidence and progression.
• Evaluation of genetic influences and clinical risk scores for CKD.

Main Results:

• Advancing age, cardiometabolic risk factors, and antiretroviral drug toxicities are key contributors to CKD in PLWH.
• Genetic factors and baseline CKD risk correlate with incident CKD, with ongoing research into tenofovir disoproxil fumarate (TDF) gene polymorphisms.
• Switching from TDF to tenofovir alafenamide (TAF) improves renal parameters in those with pre-existing renal dysfunction.

Conclusions:

• Several factors contribute to declining kidney function and CKD in PLWH.
• Clinical risk scores can aid ART selection in aging PLWH.
• Avoiding potentially nephrotoxic ART in individuals with baseline renal impairment is crucial.