AIDS_24(11)1667#1678_RCI1AL4152 - (Page 1667)

Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients Amanda Mocrofta, Ole Kirkb, Peter Reissc, Stephane De Witd, Dalibor Sedlaceke, Marek Beniowskif, Jose Gatellg, Andrew N. Phillipsa, Bruno Ledergerberh, Jens D. Lundgrenb,i, for the EuroSIDA Study Group Objectives: Chronic kidney disease (CKD) in HIV-positive persons might be caused by both HIV and traditional or non-HIV-related factors. Our objective was to investigate long-term exposure to specific antiretroviral drugs and CKD. Design: A cohort study including 6843 HIV-positive persons with at least three serum creatinine measurements and corresponding body weight measurements from 2004 onwards. Methods: CKD was defined as either confirmed (two measurements 3 months apart) estimated glomerular filtration rate (eGFR) of 60ml/min per 1.73m2 or belowfor persons withbaselineeGFRofabove60ml/minper1.73m2 orconfirmed25%declineineGFRfor persons with baseline eGFR of 60ml/min per 1.73m2 or less, using the Cockcroft–Gault formula. Poisson regression was used to determine factors associated with CKD. Results: Twohundred and twenty-five (3.3%) persons progressed toCKDduring 21482 person-years follow-up, an incidence of 1.05 per 100 person-years follow-up [95% confidence interval (CI) 0.91–1.18]; median follow-up was 3.7 years (interquartile range 2.8–5.7). After adjustment for traditional factors associated with CKD and other confounding variables, increasing cumulative exposure to tenofovir [incidence rate ratio (IRR) per year 1.16, 95% CI 1.06–1.25, P<0.0001), indinavir (IRR 1.12, 95% CI 1.06–1.18, P<0.0001), atazanavir (IRR 1.21, 95% CI 1.09–1.34, P¼0.0003) and lopinavir/r (IRR 1.08,95%CI 1.01–1.16, P¼0.030) were associated with a significantly increased rate of CKD. Consistent results were observed in wide-ranging sensitivity analyses, although of marginal statistical significance for lopinavir/r. No other antiretroviral dugs were associated with increased incidence of CKD. Conclusion: In this nonrandomized large cohort, increasing exposure to tenofovir was associated with a higher incidence of CKD, as was true for indinavir and atazanavir, whereas the results for lopinavir/r were less clear.  2010 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2010, 24:1667–1678 Keywords: antiretroviral drugs, chronic kidney disease, estimated glomerular filtration rate College London Medical School, London, UK, bCopenhagen HIV Programme, PanumInstitute, University of Copenhagen, Copenhagen, Denmark, cAcademisch Medisch Centrum bij de Universiteit van Amsterdam, Center for Infection and Immunity Amsterdam and Center for Poverty Related Communicable Diseases, Amsterdam, The Netherlands, dSt Pierre Hospital, Brussels, Belgium, eAIDS Centre, University Hospital, Medical Faculty, Charles University, Plzen, Czech Republic, fDepartment for AIDS Diagnostics and Therapy, Chorzow, Poland, gHospital Clinic i Provincial, Barcelona, Spain, hUniversity Hospital Zu Rigshospitalet, Copenhagen, Denmark. ¨rich, University of Zu ¨rich, Zu Tel: +44 20 7830 2239; fax: +44 20 7794 1224; e-mail: a.mocroft@ucl.ac.uk Received: 8 February 2010; revised: 16 March 2010; accepted: 17 March 2010. DOI:10.1097/QAD.0b013e328339fe53 1667 ¨rich, Switzerland, and iCentre for Viral Disease KMA, Correspondence to Dr Amanda Mocroft, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, Rowland Hill St, London NW3 2PF, UK. aHIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, Division of Population Health, University

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