article · Southern African Journal of HIV Medicine
Kidney disease represents an increasing non-AIDS comorbidity among people living with HIV. A cross-sectional study in Dar es Salaam, Tanzania, assessed kidney disease and structural changes in 323 adults undergoing tenofovir disoproxil fumarate based second-line antiretroviral therapy. Participants had a median age of 44 years and had received treatment for a median of 49 months, with 60 percent taking atazanavir boosted with ritonavir. A low estimated glomerular filtration rate was detected in 22 percent of individuals, occurring at a significantly higher proportion in those receiving atazanavir/ritonavir than in those on lopinavir/ritonavir. Ultrasonography revealed that nearly one-third of participants displayed a triad of renal calcinosis, renal stones, and nephritis. Furthermore, individuals receiving the atazanavir-based regimen presented significantly smaller kidney volumes alongside higher rates of nephritis and kidney stones.
While antiretroviral regimens are vital for managing HIV, specific drug combinations can harm long-term organ health. Recognising that certain second-line therapies are tied to higher rates of kidney impairment and physical damage helps healthcare providers identify vulnerable patients earlier. This enables better treatment choices to preserve kidney function over time.
The abstract outlines observational clinical findings rather than a commercial product or service, so it does not indicate a direct application pathway. However, the insights could inform clinical guidelines and treatment protocols used by healthcare providers and programme managers monitoring renal safety in antiretroviral therapy.
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Background: Kidney disease is a growing non-AIDS-related comorbidity among people living with HIV (PLWH). Tenofovir disoproxil fumarate (TDF) can result in proximal tubulopathy and acute tubular injury, whereas atazanavir/ritonavir (ATV/r) can cause interstitial nephritis and renal stones, both of which can lead to chronic kidney disease. Objectives: To examine the relationship between second-line combination antiretroviral therapy (ART) and the risk of kidney disease and morphological changes among PLWH in Dar es Salaam, Tanzania. Method: A cross-sectional study of adult PLWH receiving TDF-based second-line ART. Socio-demographic and clinical data were gathered, and laboratory tests were conducted to determine the estimated glomerular filtration rate (eGFR). Ultrasonography was performed to visualise the kidneys. Results: A total of 323 patients were enrolled (67.8% women), with a median age of 44 (interquartile range [IQR]: 39–51) years. Patients were on second-line ART for a median of 49 [IQR: 25–73] months, and 60% received ATV/r. Low eGFR (< 90 mL/min per 1.73 m2) was found in 22% of patients, proportionately higher among patients on ATV/r compared to those on a lopinavir/ritonavir (LPV/r) (P < 0.05). Nearly one-third (32.2%) of patients had a triad of renal calcinosis, renal calculi, and nephritis on ultrasonography. Patients using ATV/r had significantly smaller kidney volumes and greater proportions of renal calculi and nephritis compared to those on LPV/r (P < 0.05). Conclusion: Adults on second-line ART containing TDF were found to have a high prevalence of renal kidney disease in the Tanzanian context. Predictors of kidney disease were older age, proteinuria, and ATV/r-based regimen as compared to LPV/r.
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DOI: 10.4102/sajhivmed.v26i1.1640
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