Use of Contemporary Protease Inhibitors and Risk of Incident Chronic Kidney Disease in Persons With Human Immunodeficiency Virus: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study

• Published in: The Journal of infectious diseases 2019-10, Vol.220 (10), p.1629-1634
• Main Authors: Ryom, Lene, Dilling Lundgren, Jens, Reiss, Peter, Kirk, Ole, Law, Matthew, Ross, Mike, Morlat, Phillip, Andreas Fux, Christoph, Fontas, Eric, De Wit, Stephane, D’Arminio Monforte, Antonella, El-Sadr, Wafaa, Phillips, Andrew, Ingrid Hatleberg, Camilla, Sabin, Caroline, Mocroft, Amanda
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiviral drugs; Confidence intervals; Data collection; Female; Follow-Up Studies; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Protease Inhibitors - adverse effects; HIV Protease Inhibitors - therapeutic use; Human immunodeficiency virus; Humans; Incidence; Kidney diseases; Major and Brief Reports; Male; Middle Aged; Prospective Studies; Proteinase inhibitors; Renal Insufficiency, Chronic - chemically induced; Renal Insufficiency, Chronic - epidemiology; Risk Assessment; Ritonavir
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jiz369

Abstract Background It is unclear whether use of contemporary protease inhibitors pose a similar risk of chronic kidney disease (CKD) as use of older protease inhibitors. Methods Participants in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study were followed up until the earliest occurrence of CKD, the last visit plus 6 months, or 1 February 2016. Adjusted Poisson regression was used to assess associations between CKD and the use of ritonavir-boosted atazanavir (ATV/r) or ritonavir-boosted darunavir (DRV/r). Results The incidence of CKD (10.0/1000 person-years of follow-up; 95% confidence interval, 9.5–10.4/1000 person-years of follow-up) increased gradually with increasing exposure to ATV/r, but the relation was less clear for DRV/r. After adjustment, only exposure to ATV/r (adjusted incidence rate ratio, 1.4; 95% confidence interval, 1.2–1.6), but not exposure to DRV/r (1.0; .8–1.3), remained significantly associated with CKD. Conclusion While DRV/r use was not significantly associated with CKD an increasing incidence with longer ATV/r use was confirmed. After >6 years median follow-up in the D:A:D study, cumulative ritonavir-boosted darunavir use was not significantly associated with a gradually increasing incidence of chronic kidney disease (CKD). In contrast, CKD incidence was 40% increased after 4 years of ritonavir-boosted atazanavir use, compared with no use ever.