abacavir and Proteinuria

Proximal renal tubular dysfunction (PRTD) of varying severity has been associated with antiretroviral toxicity, especially related to the use of tenofovir (TDF). The aim of this study was to investigate whether HIV-infected patients who use a tenofovir-based regimen are at increased risk of tubular dysfunction. We conducted an observational, comparative, longitudinal, prospective study. Estimated glomerular filtration rate (eGFR) and markers of tubular damage to assess tubular dysfunction (fractional excretion of phosphate and uric acid, glycosuria, and proteinuria) were measured at baseline and at weeks 12 and 24. Of 111 participants, PRTD was found in 6.3% at week 12 and 9% at week 24, with no statistically significant difference between those on an abacavir (ABC)-containing regimen or a TDF-containing regimen. We also found an increase in triglycerides associated with the ABC-containing regimen compared with the TDF group. The use of an ABC- or TDF-containing regimen was independently associated with tubular dysfunction, but we found no significant differences between these groups, except when TDF was combined with a protease inhibitor. A better and more complete assessment of renal function is needed, because the presence of tubular dysfunction and proteinuria without impairment of eGFR may affect the renal safety of HIV-infected patients.

Topics: Adenine; Adolescent; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Dideoxynucleosides; Drug Therapy, Combination; Female; Glomerular Filtration Rate; HIV Infections; Humans; Kidney Tubules, Proximal; Longitudinal Studies; Male; Mexico; Middle Aged; Organophosphonates; Prospective Studies; Protease Inhibitors; Proteinuria; Tenofovir

It is unknown whether systemic endothelial dysfunction underlies the association between nephropathy and cardiovascular disease (CVD) in persons infected with human immunodeficiency virus (HIV). Spot urine protein to creatinine ratio, spot urine albumin to creatinine ratio, creatinine clearance, estimated glomerular filtration rate, and flow-mediated dilation (FMD) of the brachial artery were evaluated in 123 study participants infected with HIV (58 receiving antiretroviral therapy [ART] and 65 not receiving ART) with no history of diabetes or hypertension. None of the renal markers, modeled as either continuous or categorical variables, correlated with FMD. Contrary to expectations, endothelial dysfunction may not be the link between nephropathy and CVD in HIV.

Topics: Adenine; Adult; Albuminuria; Alkynes; Anti-HIV Agents; Benzoxazines; Brachial Artery; Chi-Square Distribution; Creatinine; Cyclopropanes; Dideoxynucleosides; Endothelium, Vascular; Female; Glomerular Filtration Rate; HIV Infections; Humans; Linear Models; Male; Middle Aged; Organophosphonates; Proteinuria; Tenofovir; Ultrasonography; Vasodilation

Topics: Anti-HIV Agents; Cardiovascular Diseases; Dideoxynucleosides; Glomerular Filtration Rate; HIV Infections; Humans; Kidney Failure, Chronic; Proteinuria