How Does HIV Treatment Affect Kidney Function?
It’s not just HIV medicines that may affect kidney function; HIV itself may cause kidney damage.
HIV may strain the cells of the kidney.
Conditions like diabetes, high BP, or others may add additional pressure on kidneys.
This increases the risk of renal damage.
Reasons for kidney damage in HIV patients:
Viral damage:
The virus may directly injure the nephrons.
It may structurally damage the cells.
Uncontrolled immune activation and HIV replication may injure kidney cells.
Antiretroviral drugs-
Modern antiretrovirals have a reduced risk of kidney damage.
Tenofovir disoproxil fumarate (TDF) and its combinations are associated with a higher risk of renal toxicity.
People using certain protease inhibitors long-term may also experience kidney side effects.
Other comorbidities –
Diabetes and high blood pressure:
Diabetes may damage small blood vessels affecting kidneys.
High blood pressure may strain the kidneys.
A person suffering from any of these diseases and HIV has a significantly increased risk of kidney damage.
Hepatitis co-infections
Viral infections like hepatitis B and C mediate immune complex formation and chronic inflammation.
They may impair the nephrons in the kidney.
They may cause an immune-mediated kidney disorder.
Ageing –
Increased age may impair kidney function.
HIV combined with other conditions at an elderly age may increase kidney risk.
Genetic factors:
People with specific genetic variations may be highly susceptible to renal damage.
HIV medicines associated with increased kidney risk:
Tenofovir Disoproxil Fumarate (TDF):
It is a commonly used medicine and is highly linked to renal toxicity.
It impairs tubular reabsorption.
It may impair the reabsorption of certain minerals, particularly phosphate.
Atazanavir (ATV):
It can precipitate in the urine.
It may form crystalline structures.
It may block urine flow and cause inflammation and injury to the nephrons.
Protease Inhibitors with boosters:
Low-dose boosters are sometimes added to protease inhibitors to enhance efficacy.
Alongside boosting therapeutic drug levels, they may also increase the toxic effects of co-administered medications.
HIV regimens with lowered risk of kidney damage:
Tenofovir alafenamide (TAF)
TAF has fewer kidney side effects.
TAF has targeted action; it directly reaches the target cells.
It is required in much lower doses compared to TDF.
Lower doses of TAF help reduce renal strain or toxicity.
INSTI-based antiretroviral regimens –
They may include INSTIs and an NRTI combination.
Some regimens eliminate tenofovir altogether (tenofovir-sparing regimens).
INSTIs have a favorable kidney-safe profile.
However, tenofovir-sparing regimens are suitable only for selected patients (such as those without chronic hepatitis B co-infection).
Can HIV medicines cause a false kidney test result?
Certain INSTIs (such as dolutegravir and bictegravir) and the booster cobicistat can block the kidney transporters that secrete creatinine.
This may mildly increase blood creatinine levels.
This elevation is usually harmless and does not indicate true renal dysfunction.
Bottom line:
Multiple factors, including HIV or its treatment, may cause renal damage.
Medicines like TDF carry a higher risk of renal toxicity in some patients.
The modern HIV regimens offer a kidney-safe option.
However, regular kidney monitoring helps evaluate long-term risk.
Aprazer Healthcare – Supporting the Global Fight against HIV
Aprazer Healthcare is an HIV medicine manufacturer.
We manufacture affordable antiretroviral combinations.
We supply HIV medicines worldwide.
As a third-party contract manufacturer, we offer a wide portfolio of targeted HIV drugs.
We have a strong distribution network in Asia, the Americas, and Africa.