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Tenofovir, Leading HIV Medication, Linked with Risk of Kidney Damage | www.ucsf.edu
reposted from ucsf.edu at
Tenofovir, Leading HIV Medication, Linked with Risk of Kidney Damage | www.ucsf.edu
Tenofovir, Leading HIV Medication, Linked with Risk of Kidney Damage | www.ucsf.edu
Tenofovir, Leading HIV Medication, Linked with Risk of Kidney Damage
Risk Remains After Drug Use Ends, Say Researchers, Who Call for Patient Monitoring
Tenofovir, one of the most effective and commonly prescribed antiretroviral medications for HIV/AIDS, is associated with a significant risk of kidney damage and chronic kidney disease that increases over time, according to a study of more than 10,000 patients led by researchers at the San Francisco VA Medical Center (SFVAMC) and the University of California, San Francisco (UCSF).
Michael G. Shlipak, MD, MPH
The researchers call for increased screening for kidney damage in patients taking the drug, especially those with other risk factors for kidney disease.
In their analysis of comprehensive VA electronic health records, the study authors found that for each year of exposure to tenofovir, risk of protein in urine – a marker of kidney damage – rose 34 percent, risk of rapid decline in kidney function rose 11 percent and risk of developing chronic kidney disease (CKD) rose 33 percent. The risks remained after the researchers controlled for other kidney disease risk factors such as age, race, diabetes, hypertension, smoking and HIV-related factors.
For individual patients, the differences in risk between users and non-users of tenofovir for each year of use were 13 percent vs. 8 percent for protein in urine, 9 percent vs. 5 percent for rapidly declining kidney function and 2 percent vs. 1 percent for CKD. “However, these numbers are based on the average risks in our study population, and patients with more risk factors for kidney disease would be put at proportionately higher risk,” said principal investigator Michael G. Shlipak, MD, MPH, chief of general internal medicine at SFVAMC and professor of medicine and epidemiology and biostatistics at UCSF.
Patients were tracked for an average of 1.2 years after they stopped taking tenofovir. They remained at elevated risk for at least six months to one year compared with those who never took the drug, suggesting that the damage is not quickly reversible, said Shlipak. “We do not know the long-term prognosis for these patients who stop tenofovir after developing kidney disease,” he cautioned.
The implications for patients already on or starting antiretroviral therapy are “mixed,” said Shlipak. “The best strategy right now is to work with your health care provider to continually monitor for kidney damage. Early detection is the best way to determine when the risks of tenofovir begin to outweigh the benefits.”
Shlipak noted that HIV, itself, increases the risk of kidney damage, while modern antiretroviral treatments clearly reduce that overall risk. “Patients need to be aware of their kidney disease risks before they start therapy, and this should influence the medications that they choose in consultation with their doctor,” he said. “For an otherwise healthy patient, the benefits of tenofovir are likely to exceed the risks, but for a patient with a combination of risk factors for kidney disease, tenofovir may not be the right medication.”
Tenofovir is used to decrease viral load and increase immune cell count in people infected with the virus. It is currently considered the preferred first line treatment for HIV because of its potency, overall low toxicity, and convenience of dosing. It is sold under a variety of names, by itself and in combination with other medications.
The study examined the medical records of 10,841 HIV-positive veterans in the national VA health care system who were new users of antiretroviral therapy from 1997 to 2007. It was published electronically in the journalAIDS on February 9.
Lead author Rebecca Scherzer, PhD, a researcher and statistician at SFVAMC and UCSF, said that the observational study was the largest and most conclusive indication so far of tenofovir’s association with kidney damage. “There have been a number of previous, smaller studies suggesting that this drug might be associated with kidney disease, but the results were mixed,” she said. “Those studies may have missed this association because they were too small, lacked appropriate lab data or excluded subjects with pre-existing renal impairment or risk factors for kidney disease.”
To be sure that tenofovir was the culprit, Scherzer and her colleagues looked for associations between 18 other antiretroviral medications and the same three measures of kidney disease: protein in urine, rapid decline in function and progression to CKD. None were associated with higher risk.
Shlipak noted that the study results are particularly strong because two of the risk factors – decline in function and CKD – indicate kidney function, while protein in urine indicates physical damage to the kidney. “These are independent markers,” he said. “To see the same drug cause both types of kidney disease gives you a very objective signal that something real is happening here.”
Shlipak emphasized that, despite tenofovir’s association with progressive kidney disease, it is an important component of effective antiretroviral therapy that may be required in many patients to control viral load.
The VA is the largest provider of HIV care in the United States, said Shlipak. “We could not have done this work without access to the VA’s system of electronic medical records,” he said. “In particular, the data kept by the VA Clinical Care Registry, located at the VA Palo Alto Health Care System, were essential to this study.”
Co-authors of the study are Michelle Estrella, MD, of Johns Hopkins School of Medicine; the late Andy I. Choi, MD, MAS, of SFVAMC and UCSF; Steven G. Deeks, MD, of San Francisco General Hospital; and Carl Grunfeld, MD, PhD, of SFVAMC and UCSF.
The study was supported by funds from the National Institutes of Health, the National Center for Research Resources, the American Heart Association and the Department of Veterans Affairs, some of which were administered by the Northern California Institute for Research and Education.
NCIRE - The Veterans Health Research Institute - is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
2.12.2012
the last encore... rk mon cher
woke up this morning
wishing i’d thanked you the day before
woke up this morning
wishing i’d thanked you the day before
let that old bright dad climb on without me
i’m not quite ready to walk out the door
i’m never ready
you’re never ready
we’re never ready
for the last encore
i’m never ready
you’re never ready
we’re never ready
to be dinosaurs
i’m never ready
you’re never ready
we’re never ready
for that old final soar
hoping to make it out of here
before another big uproar
rk.
Our Beloved richard kearns 1951 - 2012
i shoulda died
longtime ago so
everything troublewise
i conjur is pure
gravy
AIDSwise in dog years
(mad in the noonday)
that’s alotta sauce
even for me . . .
—rk
Richard Kearns, 60, of Los Angeles, long-time AIDS survivor, poet journalist and medical cannabis activist, passed peacefully, on January 12, 2012, with loved-ones at his side.
Mr. Kearns, a native of Chicago, was born May 26, 1951. He received his B.A. in Journalism from Roosevelt University in Chicago, IL, in 1972, and completed additional coursework at Michigan State University and Cornell College in Mt. Vernon, Iowa. Richard worked as a writer, reporter, editor and graphic designer for many publications such as Chicago Today, Gallery Magazineand the Bulletin of the Science Fiction Writers of America. He was also a consultant in professional desktop publishing and taught Journalism at Loyola Marymount University in Los Angeles, CA.
A Nebula Award nominee and graduate of the Clarion Writers’ Workshop, Richard Kearns published numerous short stories including Grave Angels which placed in the 1987 Locus Poll Award for Best Novelette, nominated for the Theodore Sturgeon Memorial Short Story Award and appears in Terry Carr’s Best Science Fiction and Fantasy of the Year. He was also a certified group exercise instructor, personal trainer and Qigong teacher.
Richard was diagnosed as HIV positive in 1987 and considered himself a long-term survivor. His political cultural activism and medical cannabis advocacy were as much a part of his AIDS treatment as was big pharma. Mr. Kearns was the founder and publisher of aids-write.org and AIDSoverSIXTY.org, both journals on HIV/AIDS positive living, LBGT political & cultural activism, art, poetry, and social justice. He served as a founding director of Patient Advocacy Network, a charitable organization advocating for safe medical cannabis laws and patients’ rights. His full bio is available at http://aidsoversixty.wordpress.com/about-rk/.
Richard Kearns is survived by activists, poets, and social justice advocates around the world. A Memorial Event, Poetry Reading & Celebration of the Life of Richard Kearns will be held on Saturday, February 11, 2012, 12 p.m. – 2:30 p.m. (rain or shine) at Kings Road Park at 1000 N. Kings Road, West Hollywood, CA 90069. Attendees are asked to consider wearing red, Richard’s favorite color and, per Richard’s request, to participate in poetry reading and storytelling.
Mr. Kearns requests memorial donations be made to The American Foundation for AIDS Research at http://www.amfar.org/donate/, Being Alive at http://www.beingalivela.org/ and Patient Advocacy Network at http://cannabissaveslives.org/.
Special thanks to West Hollywood Councilmember Jeffrey Prang, the City of West Hollywood, Los Angeles City Councilmember Bill Rosendahl, 29th Congressional District Candidate David Hernandez, Rev. Patrick Duff, Dr. Linda Bannister of Loyola Marymount University Department of English, Degé Coutee of Patient Advocacy Network, Tere Joyce of Hollywood Hemptress Hour, The Candy Factory of North Hollywood, Wellness Caregivers of Tarzana and La Brea Collective.
2.11.2012
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