Age, Tenofovir and the Kidneys

In high-income countries, tenofovir is a widely prescribed anti-HIV drug that is sold and co-formulated under the following names:

• Viread (tenofovir)
• Truvada (tenofovir + FTC)
• Atripla (tenofovir + FTC + efavirenz (Sustiva))

In general, clinical trials have found that tenofovir is well tolerated, safe and effective when used as part of HIV combination therapy.

Although tenofovir is generally safe, like all medicines (and some herbs) it can have side effects. Clinical trials done several years ago have found that about 2% of tenofovir users can develop detectable kidney dysfunction. And, in very rare cases, some people have developed severe kidney damage. Generally, this damage heals sometime after affected people stop taking tenofovir.

Is it Age or AIDS?

As we approach the fourth decade since the appearance of AIDS, larger numbers of HIV positive people in high-income countries are entering middle age or nearing retirement. This has happened because of the life-prolonging effects of highly active antiretroviral therapy (HAART). But as HIV positive people age, they become prone to other health conditions commonly seen in people who are 50 years or older. One of these conditions is chronic kidney disease (CKD). In HIV negative people, CKD is linked to the following conditions:

• diabetes
• higher-than-normal blood pressure
• cardiovascular disease

Doctors and their HIV positive patients are concerned about an intersection of several factors such as these:

• the long-term impact of HIV infection
• ageing
• any impact that long-term exposure to tenofovir may have on kidney health

In this issue of TreatmentUpdate we explore a relatively recent and large study of kidney health and tenofovir in HIV positive people.

Want to read more articles in the July/August 2009 issue of Treatment Update? Click here.