Antiretrovirals excluding tenofovir OK for HIV patients with kidney problems

the Clinical Advisor take:

Antiretroviral therapy, excluding tenofovir, is beneficial for HIV-infected patients either at high risk for or diagnosed with moderate-to-severe kidney problems, according to updated guidelines issued by the Infectious Diseases Society of America (IDSA) published in Clinical Infectious Diseases.

Patients diagnosed with HIV and kidney problems are at increased risk for developing end-stage renal disease (ESRD). African-American patients who are HIV-positive have a four-to-five-fold increased risk of developing ESRD compared with uninfected African-American patients.

“Even mild chronic kidney disease poses a substantially increased risk of cardiovascular disease and death,” explained Gregory Lucas, MD, of Johns Hopkins University, co-chair of the guidelines, in a press release.

HIV-positive patients with clinically decreased kidney function are less likely to be prescribed ART, due to concerns about medications being cleared by the kidneys. The guideline authors suggest, however, that health-care providers look into alternative HIV treatment options.

“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,” noted Lucas.