Patients who take one of the most widely prescribed drugs to treat HIV infection increase their risk of kidney damage by up to 34 percent every year they take the medication, according to a study of more than 10,000 HIV-positive veterans.
The study, by the San Francisco VA Medical Center and published online earlier this month, is one of the largest to address the long-term risk of tenofovir, an antiretroviral drug that is taken daily, usually in a single pill combined with other drugs.
Doctors have long known that antiretroviral drugs carried some risk of kidney damage, but how much – and whether that damage is caused by a particular drug or combination of drugs, or by the HIV infection itself – has been the source of much debate.
And it’s a debate that is likely to become more heated. For many HIV-infected patients, the benefits of taking tenofovir and preventing full-blown AIDS will far outweigh the risk of long-term kidney damage. But some public health experts have begun to promote the drug for healthy individuals after recent research showed that tenofovir could prevent HIV infection.
With the new findings, the pros and cons become a little murkier, researchers say.
"You’re willing to sacrifice a little bit of long-term kidney damage when it’s keeping you alive in the short-term," said Dr. Michael Shlipak, chief of general internal medicine at the VA medical center and an author of the study. "But as HIV becomes a longer and longer chronic disease, people may be on these drugs for 20 years, and that risk is really going to add up.
"Then you take it to people who don’t even have HIV, you’re talking all risk and potentially marginal benefit."
No one is recommending that patients stop taking tenofovir and other antiretroviral drugs or that doctors should not prescribe it. Shlipak and other HIV/AIDS experts noted that those medications have been remarkably successful in treating HIV. In the United States, many patients are living years and even decades with their infection in check.
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