Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate: a prospective international cohort study. The Lancet HIV
Mocroft et al. on behalf of the D:A:D study aimed to investigate the association between duration of exposure to antiretrovirals and the development of chronic kidney disease in people with initially normal renal function. Out of 23’905 study-participants, 285 (1%) developed chronic kidney disease during a median follow-up of 7.2 years, giving an incidence of chronic kidney disease of 1.76 per 1’000 person-years of follow-up. After adjustment for potential confounding variables, there was a 14%, 20%, and 11% increase in chronic kidney disease associated with each additional year of exposure to tenofovir disoproxil fumarate, ritonavir-boosted atazanavir, and ritonavir-boosted lopinavir, respectively. There was no increased incidence of chronic kidney disease with either abacavir or other ritonavir-boosted inhibitors.
In conclusion, the incidence of chronic kidney disease in HIV-positive individuals increases continuously with duration of exposure to specific antiretrovirals, with no evidence that the development of chronic kidney disease is limited to the first few months of starting antiretrovirals and no plateau in the increasing incidence after a median follow-up of more than 6 years.