Journal of Antivirals & Antiretrovirals
Open Access

Abstract

A Comparative Analysis of Risk Factors Associated With Renal Impairment and Highly Active Antiretroviral Therapy

Neesha Rockwood, Sundhiya Mandalia, Julia Sirokosta, Brian Gazzard and Mark Nelson

Background: The effect of boosted protease inhibitors (PI) on renal function is unclear.
Methods: We assessed and compared the risk of developing renal impairment in individuals commencing 3 first line PI-based regimens vs a non-nucleoside reverse transcriptase inhibitor- based regimen. Patients commencing efavirenz, darunavir, atazanavir or lopinavir with 2 nucleos(t)ide reverse transcriptase inhibitors from June 2006 - February 2010, with baseline eGFR>60ml/min per 1.73m2 were included. Univariate and adjusted Cox’s proportional hazards regression models were used to examine likelihood of developing renal impairment (defined as eGFR< 60ml/min per 1.73m2).
Results: 386 of 2115 treated individuals developed renal impairment over 2680 person years of follow up. By univariate analysis, female gender (HR 1.51, p 0.002), baseline age (p<0.001), baseline eGFR (p<0.001), darunavir (HR 1.53, p<0.001), atazanavir (HR 1.27, p 0.036), lopinavir (HR 1.71, p<0.001), prior tenofovir exposure (HR 1.68, p<0.001), prior indinavir exposure (HR 2.03, p<0.001) and total duration of tenofovir exposure (HR 1.09, p<0.001) were associated with an increased risk of renal impairment. By multivariate analysis, treatment with atazanavir (HR 1.52, p 0.004) and lopinavir (HR 1.61, p<0.017) but not darunavir (HR 1.31, p 0.108) were associated with an increased risk of renal impairment compared with efavirenz.
Conclusion: There was a significantly increased risk of developing renal impairment associated with atazanavir and lopinavir independent of exposure to tenofovir.