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Ask the Experts About Kidney Health and HIV
We Asked a Kidney Specialist (a Nephrologist), a Pharmacist and a Naturopath to Share Their Tips and Insights on How People With HIV Can Be Kind to Their Kidneys

Winter 2012

Alireza Zahirieh, M.D.

Nephrologist, HIV Renal Disease Clinic
Sunnybrook Health Sciences Centre
Toronto

The prevention and treatment of kidney disease go hand in hand. A healthy lifestyle is essential for both. That means regular exercise, eating a well-balanced diet according to Canada's Food Guide, and cutting back on alcohol, tobacco and street drugs. People with HIV should also see their physicians and get screened regularly for kidney disease.

Kidney disease appears to be more common among people living with HIV than in the general population. Many of my patients have kidney disease that is not related to their HIV infection but rather to traditional risk factors -- such as diabetes, high cholesterol, hypertension and smoking -- which are all more common among people with HIV. To manage kidney disease, one should manage the risk factors as much as possible. This includes controlling HIV with antiretroviral therapy.

Kidney disease has much in common with cardiovascular disease. In general, what's good for the heart is good for the kidneys. The chronic inflammation observed in some individuals with HIV infection puts them at risk for atherosclerosis (hardening of the arteries) and thus at risk for heart attacks, strokes and chronic kidney disease. Fortunately, treating kidney disease also treats these other serious diseases.

When it comes to kidney disease, one must pay particular attention to drug-related kidney injury. Certain drugs are more likely to cause kidney injury, but almost any drug can cause an allergic reaction that affects the kidneys. To avoid injuring the kidneys, it is very important to ensure that medications are taken at appropriate doses. Also, when starting a new drug or changing the dose of a current drug, careful monitoring is often required. Certain over-the-counter medications, such as ibuprofen (Advil, Motrin) or high doses of Aspirin, may cause kidney disease in individuals at risk for this complication. Finally, drug interactions can cause potentially dangerous adverse effects; it is crucial that your healthcare providers know the names of all the medications you're taking, including over-the-counter products and supplements.

In summary, a healthy lifestyle, aggressive treatment of risk factors for chronic kidney disease (including HIV infection), careful use of medication and a well-balanced diet will help protect your kidneys.


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Jeff Kapler, B.Sc.Pharm.

HIV specialty pharmacist
Southern Alberta Clinic for HIV/AIDS
Calgary

Many meds can affect kidney health, including some antiretrovirals. Certain antibiotics and blood pressure meds, anti-inflammatories and street drugs can all cause kidney damage. It is important for people who are at higher risk for kidney disease to use over-the-counter medication with caution. If someone is on anti-HIV drugs and has borderline kidney function, ibuprofen can tip the scales and cause additive kidney damage. For fever or pain relief, acetaminophen (Tylenol) is a good alternative, unless a person has severe liver disease.

Like many drugs, tenofovir (Viread, also in Truvada, Atripla and Complera) is cleared from the body by the kidneys. There are cases of kidney damage among people taking tenofovir. Results from a French cohort study looking at tenofovir's contribution to kidney disease were presented at the 2011 International AIDS Society conference in Rome. Of the roughly 2,700 participants on tenofovir, less than 5 percent developed chronic kidney disease. Of those who did develop chronic kidney disease, 90 percent already had reduced kidney function when they started taking tenofovir and they had other risk factors as well. If a patient is at considerable risk for kidney disease, I would recommend other options if available. However, tenofovir is not a drug to avoid in general, and especially if there are no other options for putting together an effective regimen.

Any medication that can cause crystals to form in the kidneys can harm the kidneys. There have been some reports of the protease inhibitor atazanavir (Reyataz) causing the formation of crystals and kidney stones, but much less so than indinavir (Crixivan), which has been associated with kidney stones in up to 13 percent of users. Indinavir is rarely used in Canada nowadays, but I recommend to my patients on atazanavir that they drink a minimum of eight glasses of water a day, especially in the summer months.

Maintaining one's overall health -- keeping cholesterol, blood sugar and blood pressure at optimal levels -- is important for the kidneys.


Agnieszka Matusik, N.D.

Doctor of Naturopathic Medicine
Burnaby Heights Integrative HealthCare
Burnaby, BC

It is important that people with HIV consume enough calories, protein, fat, water and other fluids, as well as antioxidants. Antioxidants protect the kidneys from nephrotoxic medications (medications that can be toxic to the kidneys) and from the harmful effects of HIV. Everyone should take a daily multivitamin and eat plenty of fruits and vegetables. A minimum of five servings of fruits and vegetables every day is optimal, including a variety of brightly coloured ones. Antioxidants clean up the free radicals created during the inflammatory response. Fish oils and omega-3 fatty acids have anti-inflammatory properties.

I prescribe antioxidants such as vitamin E, vitamin C, selenium and n-acetyl-cysteine (NAC), to help the body produce glutathione, an important antioxidant that can't be directly supplemented. Some botanical medicines or herbs can protect the kidneys and stimulate the immune system; several studies support the use of astragalus, curcumin (turmeric), alpha-lipoic acid, coenzyme Q10 and spirulina. Curcumin is one of the best.

If someone develops kidney disease, their vitamin D levels should be tested and if they're too low, supplemented, because the kidneys are involved in making vitamin D. A person shouldn't take too much vitamin C because this can in some cases contribute to kidney stones.

It is important to talk to a health professional, like a naturopathic doctor, before taking any supplements. The dosage must be tailored to the individual and should take into consideration any other conditions they may have and other medications they may be taking.




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