An updated HIVMA and IDSA guideline for the treatment of chronic kidney disease in patients infected with HIV is available online. Published in the Nov. 1 issue of Clinical Infectious Diseases, the new document updates guidance last issued in 2005. Antiretroviral therapy (ART) is beneficial for the 5 to 10 percent of HIV-infected patients with reduced kidney function, with the exception of tenofovir—the most widely prescribed ART—which can lead to moderate kidney damage in some patients, according to the updated guideline.
“Research shows HIV patients who have clinically decreased kidney function are less likely to be prescribed ART, probably because physicians and other health care providers are concerned that many of these medications are cleared by the kidneys and don’t want to cause further harm,” said Gregory Lucas, MD, associate professor at Johns Hopkins School of Medicine and co-chair of the guideline panel. “But the outlook for HIV patients with kidney disease is much better now that we have numerous effective treatments for HIV, many of which are not cleared by the kidneys.”
The guideline also recommends kidney transplantation as a viable option in HIV-infected patients whose kidneys are failing. Despite previous concerns that these patients would not fare well on the immunosuppressive therapy necessary to prevent the body from rejecting the organ, initial research suggests they are as likely to survive and maintain a functioning organ as transplant recipients without HIV infection.
Those caring for HIV patients should monitor both kidney function, by estimating glomerular filtration rate (GFR), and kidney damage, with urinalysis or urine protein, the guideline recommends. As many as one in 10 people with HIV have decreased kidney function, and up to twice as many may have other evidence of kidney damage.
Mobile device and pocket-card versions of the updated guideline are available for use at the point of care. These and other clinical tools can be accessed through the practice guidelines section of the IDSA website.
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