Renal function and incidence of chronic kidney disease in HIV patients: A Danish cohort study

Abstract

Background: Impaired renal function is of major concern in human immunodeficiency virus (HIV)-infected patients. Methods: We used a mixed effects linear regression model to determine estimated glomerular filtration rates (eGFRs) in a population-based cohort of incident Danish HIV patients and stratified on baseline eGFR (eGFR_B) < 90 and ≥ 90 ml/min per 1.73 m². Incidence rate ratios (IRRs) for chronic kidney disease (CKD) – 2 consecutive eGFR values < 60 ml/min per 1.73 m² measured > 3 months apart – were estimated (time-updated Cox-regression model). Results: The effect of time with HIV on eGFR was small in both strata (− 0.09 (95% confidence interval (CI) − 0.27, 0.09) and − 0.46 (95% CI − 0.64, − 0.27) ml/min per 1.73 m² per y). Treatment with tenofovir and indinavir was associated with lower eGFR in both strata: tenofovir − 2.00 (95% CI − 3.45, − 0.56) and − 1.94 (95% CI − 3.43, − 0.44) ml/min per 1.73 m² and indinavir − 2.14 (95% CI − 3.63, − 0.64) and − 3.29 (95% CI − 5.25, − 1.32) ml/min per 1.73 m². Nevirapine, atazanavir, and the combination of tenofovir and atazanavir were associated with lower eGFR in patients with eGFR_B < 90 ml/min per 1.73 m². Highly active antiretroviral therapy (HAART) and exposure to tenofovir and atazanavir in combination were associated with CKD in patients with eGFR_B < 90 ml/min per 1.73 m² (adjusted IRRs 6.08 (95% CI 2.76–13.41) and 26.75 (95% CI 9.54–75.05)). Conclusion: Tenofovir and indinavir reduce eGFR, while time with HIV only has a modest effect on this parameter. Low eGFR_B is associated with an increased risk of CKD, especially when receiving HAART regimens containing the combination tenofovir/atazanavir.

Keywords::

• Chronic kidney disease
• HIV
• atazanavir
• tenofovir
• renal function

Acknowledgements

We thank the staff of our clinical departments for their continuous support and enthusiasm. We also thank the AIDS Foundation, the NOVO Nordisk Foundation, and the Clinical Institute of Copenhagen University for financial support. No funding sources were involved in the study design, data collection, analysis, report writing, or the decision to submit the paper. Centres in the Danish HIV Cohort Study: Departments of Infectious Diseases at Copenhagen University Hospitals, Rigshospitalet (J. Gerstoft, N. Obel) and Hvidovre (G. Kronborg), Odense University Hospital (C. Pedersen), Aarhus University Hospitals, Skejby (C. S. Larsen) and Aalborg (G. Pedersen), Herning Hospital (A. L. Laursen), Helsingør Hospital (L. Nielsen), and Kolding Hospital (J. Jensen).

Declaration of interest: N. Obel has received research funding from Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, Abbott, Boehringer Ingelheim, Janssen-Cilag, and Swedish Orphan. C. Pedersen has received research funding from Abbott, Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, Swedish Orphan, and Boehringer Ingelheim. J. Gerstoft has received research funding from Abbott, Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, Pharmasia, GlaxoSmithKline, Swedish Orphan, and Boehringer Ingelheim. O. Kirk has received funding (including advisory boards, research funding, conference participation, lectures) from Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Janssen-Cilag, Merck Sharp & Dohme, Roche, and Viiv. M. G. Rash, F. N. Engsig, B. Feldt-Rasmussen, and G. Kronborg, report no conflicts of interest.