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Improved kidney function in patients who switch their protease inhibitor from atazanavir or lopinavir to darunavir

Jose, S; Nelson, M; Phillips, A; Chadwick, D; Trevelion, R; Jones, R; Williams, DI; ... Post, FA; + view all (2017) Improved kidney function in patients who switch their protease inhibitor from atazanavir or lopinavir to darunavir. AIDS , 31 (4) pp. 485-492. 10.1097/QAD.0000000000001353. Green open access

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Abstract

OBJECTIVE: Atazanavir (ATV) and lopinavir (LPV) have been associated with kidney disease progression in HIV positive patients, with no data reported for darunavir (DRV). We examined kidney function in patients who switched their protease inhibitor from ATV or LPV to DRV. DESIGN: Cohort study. METHODS: Data were from the UK CHIC study. We compared pre and post switch estimated glomerular filtration rate (eGFR) slopes (expressed in ml/min per 1.73 m2 per year) in all switchers and those with rapid eGFR decline (>5 ml/min per 1.73 m2 per year) on ATV or LPV. Mixed-effects models were adjusted for age, gender, ethnicity, eGFR at switch and time updated CD4þ cell count, HIV RNA and cumulative tenofovir (tenofovir disoproxil fumarate) exposure. RESULTS: Data from 1430 patients were included. At the time of switching to DRV, median age was 45 years, 79% were men, 76% had an undetectable viral load, and median eGFR was 93 ml/min per 1.73 m2 . Adjusted mean (95% confidence interval) pre and post switch eGFR slopes were 0.84 (1.31, 0.36) and 1.23 (0.80, 1.66) for ATV (P < 0.001), and 0.57 (1.09, 0.05) and 0.62 (0.28, 0.96) for LPV (P < 0.001). Stable or improved renal function was observed in patients with rapid eGFR decline on ATV or LPV who switched to DRV [15.27 (19.35, 11.19) and 3.72 (1.78, 5.66), P < 0.001 for ATV, 11.93 (14.60, 9.26) and 0.87 (0.54, 2.27), P < 0.001 for LPV]. Similar results were obtained if participants who discontinued tenofovir disoproxil fumarate at the time of switch were excluded. CONCLUSIONS: We report improved kidney function in patients who switched from ATV or LPV to DRV, suggesting that DRV may have a more favourable renal safety profile.

Type: Article
Title: Improved kidney function in patients who switch their protease inhibitor from atazanavir or lopinavir to darunavir
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001353
Publisher version: http://doi.org/10.1097/QAD.0000000000001353
Language: English
Additional information: Copyright Q 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Atazanavir, darunavir, HIV, kidney, lopinavir
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1540005
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