WEPDB0104 - Poster Discussion Session
Antiretroviral drugs and incidence of chronic kidney disease, ANRS CO3 Aquitaine cohort (2004-2008)
Presented by Philippe Morlat (France).
P. Morlat1,2, A. Vivot3, F. Dauchy1, J. Asselineau3, M.-A. Vandenhende1, E. Lazaro1, Y. Gérard4, F. Bonnet1,2, D. Neau1, P. Mercié1,2, E. Déti2, G. Chêne2,3, Groupe d'Epidémiologie Clinique du SIDA en Aquitaine
1CHU de Bordeaux, Services de Médecine Interne et Maladies Infectieuses, Bordeaux, France, 2Université Bordeaux Segalen, INSERM U 897, Bordeaux, France, 3CHU de Bordeaux, USMR, Bordeaux, France, 4CH de Dax, Service de Maladies Infectieuses, Dax, France
Background: We examined the role of antiretroviral drugs (ART) on the incidence of chronic kidney disease (CKD) in HIV-infected patients.
Methods: Creatinine clearance (CC) was estimated using the modification of diet in renal disease formula in a multicenter cohort. CKD was defined as a CC< 60 ml/min/1.73m2 (two consecutive measurements ≥ 3 months apart). A Poisson regression model was used to investigate determinants of CKD measured at baseline, or updated [CD4+ lymphocytes count, HIV-RNA, cumulative exposure to ART].
Results: From January 2004 until December 2008, 2692 patients (76% men) with baseline CC>60 ml/min/1.73m2 were included and followed for a median of 3.4 years. Mean age was 42 years and median delay since HIV diagnosis 9.2 years; 21% had a history of AIDS; 80% were treated by ART. At the end of follow-up, 95% had received ART (mean cumulative exposure 7.5 years) among whom 35% received jointly (>6 months) tenofovir and a protease inhibitor (PI) [mainly atazanavir/r or lopinavir/r]. The average incidence rate of CKD was 10.1 cases per 1000 persons-years. 95% of those developing CKD had a baseline CC between 60 and 90. Incidence of CKD was higher (p< 0.05) among women (HR=1.94), older patients (>60 y: HR=3.68 and 45-60y: HR=1.95), with diabetes (HR=2.19), hyperlipidemia (HR=2.07), low baseline CC (HR=48 for 60< CC< 70 ; HR=19 for 70< CC< 80), latest CD4+< 200 cells/mm3 (HR=3.72), and exposure to tenofovir (HR=2.34 for >6 months). After 1 year of exposure, tenofovir was associated with a higher risk of CKD when co-administered with PI (HR=2.4 for 1-2 years; HR=3.4 for >2 years).
Conclusion: Cumulated exposure to tenofovir was associated with a higher incidence of CKD, as was true for preexisting mild renal impairment, traditional risk factors of CKD, severe immunodeficiency and female gender. Concomitant use of tenofovir and PI requires particular vigilance to prevent occurrence of CKD.
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