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Renal tubular disease in the era of combination antiretroviral therapy.
- Source :
-
AIDS (London, England) [AIDS] 2015 Sep 10; Vol. 29 (14), pp. 1831-6. - Publication Year :
- 2015
-
Abstract
- Objectives: To describe the spectrum of renal tubular disease (RTD) in HIV-positive patients and its association with exposure to antiretroviral therapy (ART).<br />Design: Review of 265 consecutive renal biopsies from HIV-positive patients attending eight clinics in the United Kingdom between 2000 and 2012.<br />Methods: We described the clinical characteristics of patients with RTD and compared current/recent exposure (at the time of, or up to 3 months prior to the date of biopsy) to potentially nephrotoxic ART [tenofovir (TDF), atazanavir (ATV), indinavir (IDV) and lopinavir/ritonavir (LPV/r)]. We also analysed the incidence of RTD in the UK CHIC cohort. Kruskall-Wallis, analysis of variance and Fisher's exact tests were used to evaluate between-group differences.<br />Results: Of the 60 RTD cases, 54 (90%) were included in the analyses. RTD comprised of three distinct patterns: acute tubular injury (ATI, n = 22), tubulo-interstitial nephritis (TIN, n = 20) and interstitial fibrosis and tubular atrophy (IFTA, n = 12). Compared with TIN and IFTA, ATI cases were less likely to be of black ethnicity (10 vs. 42-55%; P = 0.006), more likely to be on ART (100 vs. 55-68%; P = 0.001), with HIV-RNA below 200 copies/ml (100 vs. 54-58%; P < 0.001), and more likely to have current/recent exposure to TDF (P < 0.001). We did not find evidence for an association between exposure to TDF, ATV/r or LPV/r and either TIN or IFTA.<br />Conclusion: RTD was present in approximately 20% of renal biopsies and comprised three distinct injury patterns with considerable clinical overlap. ATI was associated with TDF exposure, although the overall incidence of biopsy-defined ATI was low.
- Subjects :
- Adult
Anti-Retroviral Agents adverse effects
Antiretroviral Therapy, Highly Active adverse effects
Biopsy
Female
Histocytochemistry
Humans
Incidence
Kidney pathology
Male
Middle Aged
United Kingdom epidemiology
AIDS-Associated Nephropathy chemically induced
AIDS-Associated Nephropathy epidemiology
Anti-Retroviral Agents therapeutic use
Antiretroviral Therapy, Highly Active methods
HIV Infections complications
HIV Infections drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5571
- Volume :
- 29
- Issue :
- 14
- Database :
- MEDLINE
- Journal :
- AIDS (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 26372389
- Full Text :
- https://doi.org/10.1097/QAD.0000000000000736