New risk score assesses chronic kidney disease risk in patients with HIV

the Clinical Advisor take:

A risk score model that assesses both traditional and HIV-related risk factors can help clinicians make informed choices about antiretroviral drugs for patients diagnosed with HIV, study findings indicate.

Although antiretroviral therapy can help control HIV, some antiretroviral drugs may be harmful to the kidney, increasing the risk of chronic kidney disease (CKD), noted Amanda Mocroft, of University College London, United Kingdom, and colleagues in PLOS Medicine.

“Clinicians may need to weigh the benefits and risks of giving such potentially nephrotoxic drugs to individuals who already have a high CKD risk.”

To develop a simple, externally validated, and widely applicable long-term risk score model for CKD in patients with HIV, the investigators culled data from 17,954 HIV-positive patients who were enrolled in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Nine factors – age, intravenous drug use, hepatitis C co-infection, estimated glomerular filtration rate, gender, CD4 count, hypertension, diabetes, and cardiovascular disease – were used to determine risk.

The study participants with a low risk score had a 1 in 393 chance of developing CKD in the following 5 years. Those who scored medium and high risk scores had a 1 in 47 chance and 1 in 6 chance, respectively, of developing CKD.

This “number needed to harm” (NNTH) for patients starting treatment with tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor was 739, 88, and 9 in the low, medium, and high risk groups, respectively.

“These findings highlight the need for monitoring, screening, and chronic disease prevention to minimize the risk of HIV-positive individuals developing diabetes, hypertension, or cardiovascular disease, or becoming coinfected with hepatitis C, all of which contribute to the CKD risk score,” concluded the investigators.