A Comparative Analysis of Risk Factors Associated With Renal Impairment and Highly Active Antiretroviral Therapy
- *Corresponding Author:
- Dr. Neesha Rockwood
Department of HIV Medicine
St Stephens Centre Chelsea and Westminster Hospital
369Fulham Road, London
SW10 9NH, United Kingdom
Tel: +44 07809446364
Fax:+440208 846 6198
E-mail: [email protected]
Received Date: February 13, 2012; Accepted Date: March 19, 2012; Published Date: March 21, 2012
Citation: Rockwood N, Mandalia S, Sirokosta J, Gazzard B, Nelson M (2012) A Comparative Analysis of Risk Factors Associated With Renal Impairment and Highly Active Antiretroviral Therapy. J Antivir Antiretrovir 4: 021-025. doi: 10.4172/jaa.1000041
Copyright: © 2012 Rockwood N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: The effect of boosted protease inhibitors (PI) on renal function is unclear.
Methods: We assessed and compared the risk of developing renal impairment in individuals commencing 3 first line PI-based regimens vs a non-nucleoside reverse transcriptase inhibitor- based regimen. Patients commencing efavirenz, darunavir, atazanavir or lopinavir with 2 nucleos(t)ide reverse transcriptase inhibitors from June 2006 - February 2010, with baseline eGFR>60ml/min per 1.73m2 were included. Univariate and adjusted Cox’s proportional hazards regression models were used to examine likelihood of developing renal impairment (defined as eGFR< 60ml/min per 1.73m2).
Results: 386 of 2115 treated individuals developed renal impairment over 2680 person years of follow up. By univariate analysis, female gender (HR 1.51, p 0.002), baseline age (p<0.001), baseline eGFR (p<0.001), darunavir (HR 1.53, p<0.001), atazanavir (HR 1.27, p 0.036), lopinavir (HR 1.71, p<0.001), prior tenofovir exposure (HR 1.68, p<0.001), prior indinavir exposure (HR 2.03, p<0.001) and total duration of tenofovir exposure (HR 1.09, p<0.001) were associated with an increased risk of renal impairment. By multivariate analysis, treatment with atazanavir (HR 1.52, p 0.004) and lopinavir (HR 1.61, p<0.017) but not darunavir (HR 1.31, p 0.108) were associated with an increased risk of renal impairment compared with efavirenz.
Conclusion: There was a significantly increased risk of developing renal impairment associated with atazanavir and lopinavir independent of exposure to tenofovir.