Renal Function and HIV

Question

Hello Doctor:

I first found out I was HIV+ in Jan '97 through yearly, anonymous testing. My doctor at the time put me on meds in May '97 and I've been undetectable ever since and my t-cell % is in the low 40's (number varies from 600s-1000).

Abut 4 years ago or so I changed to Truvada and Isentress because I was uncomfortable with my CD4% going down to the low 30s (on Truvada and Viramune). Now, at my last two lab visits (May and August of '16) my formerly absolutely normal eGFR dropped below 60 to 56 then 53. I also had a significant amount of protein in my urine in May (not tested since then). So I'm totally freaked out about renal failure now. My doc said it was probably the Truvada so he switched me to Triumeq. I do have HTN and DM2 but both are under control.

My question is, if the Truvada is causing this will my renal function eventually go back to normal? Will it just sit where it is? Or am I doomed for dialysis someday? I'm confused as to what to do but my doc doesn't seem very worried at this point. Should I see a nephrologist?

Thank you for you time.

Answer

The change in eGFR is likely multifactorial, meaning, several things are likely contributing to a reduced eGFR. You don't indicate what the eGFR was prior to starting Truvada 4 years ago. Where you already at 60, or was it significantly higher? The tenofovir in Truvada could certainly have been a factor over time. Age, hypertension, and diabetes are also likely contributory. If you were already at 60, you may see some increase back to that level after discontinuing Truvada. There certainly could be other medical conditions, in addition to what is going on already, that could contribute to a decreasing eGFR. So yes, I think seeing a nephrologist would be a good idea, as they can help eliminate any other possible causes.