POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: buginme2 on February 11, 2012, 01:37:07 pm
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This study of 10,000 patients conducted by UCSF found that for each year of exposure to Tenofovir the risk of developing chronic kidney disease rose 33 percent. The study even suggested that after Tenofovir was stopped the effect remained for at least a year.
http://www.ucsf.edu/news/2012/02/11508/tenofovir-leading-hiv-medication-linked-risk-kidney-damage
Its always something, isn't it?
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Indeed, but they key question here (as with abacavir and heart disease) is what is your underlying risk of kidney disease? Mine is 0.3% over 5 years, so I am happy with an increase to around 1%. It's lower than my risk of heart attack on abacavir. Or as my labs show after 6 years on tenofovir, no kidney disease indicators, so what's the big deal?
Moral: get a urine dispstick test every time you do labs, or eGFR or creatinine clearance as appropriate, if you are on tenofovir/Truvada/Atripla << last test as recommended by the package insert.
But more importantly, WE NEED BETTER DRUGS, not easy-to-take-but-just-good-enough-for-now-considering ones.
- matt
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Question, my doctor has never done a urine test but does do a egfr and creatanine test on each blood draw. Is a urine test needed? If you have a history of kidney stones (i do) are there any additional tests needed? How often should u get your blood work done? I go every 6 months.
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Question, my doctor has never done a urine test but does do a egfr and creatanine test on each blood draw. Is a urine test needed?
No, these are the mothers of all kidney function tests so you are sorted, and your doc is smart. << as long as he does blood sugar too to check for insulin resistance.
6 months between labs is fine in my book if all is well, eg viral load undetectable, CD4 count up, other test results okay. << I go 2 times a year now
- matt
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Thanks!
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I guess that supports another good benefit of dropping my viread...
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does do a egfr and creatanine test on each blood draw.
Anyone on Tenofir is getting these, or should be. If not, demand it and maybe start looking for another doc.
I was taken off Truvada after 2 years due to declining Kidney function, it still hasnt rebounded but doc says it should over time.
-W
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Anyone on Tenofir is getting these, or should be. If not, demand it and maybe start looking for another doc.
I was taken off Truvada after 2 years due to declining Kidney function, it still hasnt rebounded but doc says it should over time.
-W
^This is why this surprises me
Any given conversation between Wump and Hellraiser:
Hellraiser: "so what did your doctor say?"
Wump: "Oh I didn't ask her anything or tell her anything that's happened to me since I saw her last"
Hellraiser: "So...you basically went to the medical dispensary and ignored everything they said?"
Wump: "I just can't pay attention!"
Hellraiser: *facepalm*
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Anyone on Tenofir is getting these, or should be. If not, demand it and maybe start looking for another doc.
I was taken off Truvada after 2 years due to declining Kidney function, it still hasnt rebounded but doc says it should over time.
-W
I'm still on Truvada been on it for the last 6 yrs (2006) I ask my Doc about why, she says "well your UD so what do u want" your combo is still working, so that's why :-[ she reduced it down to every other day tho....
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I've been on tenofovir since it was FDA approved a decade ago. I've always had the eGFR, creatinine, BUN, glucose serum, etc. stuff on every set of labs spanning four doctors.
Considering how widely this is prescribed (In fact I would assume the most widely) I think if there was a acute kidney issue going on (of course some people will have issues) you'd see thread after thread about it on this forum and I'd be running into the issue with pozzies I know locally.
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I've been on tenofovir since it was FDA approved a decade ago. I've always had the eGFR, creatinine, BUN, glucose serum, etc. stuff on every set of labs spanning four doctors.
Considering how widely this is prescribed (In fact I would assume the most widely) I think if there was a acute kidney issue going on (of course some people will have issues) you'd see thread after thread about it on this forum and I'd be running into the issue with pozzies I know locally.
Yeah, I'm kinda not really buying this whole Kidney Damage thing, I've had kidney issues long before tenofovir was even made, always had kidneys stones as far back as I can recall ::)
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Yeah, I'm kinda not really buying this whole Kidney Damage thing,
What are you not buying, the damage is real. But it only happens in a very small percentage of people.
-W
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^This is why this surprises me
Any given conversation between Wump and Hellraiser:
Hellraiser: "so what did your doctor say?"
Wump: "Oh I didn't ask her anything or tell her anything that's happened to me since I saw her last"
Hellraiser: "So...you basically went to the medical dispensary and ignored everything they said?"
Wump: "I just can't pay attention!"
Hellraiser: *facepalm*
Nice way to hijack. *facepalm* indeed!
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Well,.... I'm just glad that I was able to stop the Viread, with no spike in viral load. I was concerned whether the Viramune and Epzicom would be enough to do the job.
To this day, I have no idea, why the doctor felt, I needed Viread added to an already existing 3 drug regimen. :-\ in 2004. I never really received an answer that satisfied me.
I did however stop the Viread in October of 09, (after 5 years). I told the doctor, that I would take my chances. Everything's been fine since.
I should go back and take a look at some of my earlier labs, while on Viread, just for the hell of it, and compare now, since I have been off Viread for about 2 years and 4 months.
My last EGFR was 76. (Range >60) Creatinine was 1.00 ( range - .64- 1.27
At one point I was wondering should I be worried about kidney risk, or about bone loss, or having a heart attack, on the Abacavir. :-\
Ray
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What are you not buying, the damage is real. But it only happens in a very small percentage of people.
-W
My Nephrologist just last week , stated that their really isn't any correlation to support this, you need to worry more about your diet, your sodium intake as well as your hypertension issues, cause that will kill your kidneys more so than any AVR you might be taking......his words, not mine , also my ID-Doc agrees with THIS ;) she however did lower my Travavda intake down to every-other-day ::)
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fyi, and I mentioned this elsewhere recently, but Gilead will hopefully be coming out with a "low dose pro-drug (http://en.wikipedia.org/wiki/Prodrug)" version of tenofovir, currently called GS-7340, which if I have read correctly will provide greater efficacy at a dose that is ten times lower than viread. This just went into Phase 2 trials, but the really lame part is that Gilead bought the rights to this around 2004 and then discontinued the trials for years and years. If they had brought this to market much earlier then we probably wouldn't be discussing the topic of this thread. But hey, you know that they must be worried about Truvada's patent expiring...
http://www.nasdaq.com/article/gilead-initiates-phase-2-trial-evaluating-gs-7340-for-treatment-of-hiv-20120124-01502
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My Nephrologist just last week , stated that their really isn't any correlation to support this, you need to worry more about your diet, your sodium intake as well as your hypertension issues, cause that will kill your kidneys more so than any AVR you might be taking......his words, not mine , also my ID-Doc agrees with THIS ;) ::)
Yeah Wumpy -- it's kind of clear with the amount of fast food you eat on a daily basis (http://forums.poz.com/index.php?topic=40712.0) that you ingest 10 times the amount of sodium as the rest of us. But hey, you know how it goes:
... it's the meds!
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Any given conversation between Wump and Hellraiser:
Hellraiser: "so what did your doctor say?"
Wump: "Oh I didn't ask her anything or tell her anything that's happened to me since I saw her last"
Hellraiser: "So...you basically went to the medical dispensary and ignored everything they said?"
Wump: "I just can't pay attention!"
Hellraiser: *facepalm*
Any given conversation between Hellraiser and WUmp:
Wump: "whats up, how you doing?"
Hellraiser: " Oh not much, I went out and got plastered and passed out in a urinal in the french quarter last night"
Wump: "Wow, cool, You still taking your dapsone?"
Hellraiser: "No, I dont like the way it tastes"
Wump: "sigh."
See. Two can play that game ;)
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Hellraiser: "No, I dont like the way it tastes"
That pretty much sums her up, doesn't it?
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That pretty much sums her up, doesn't it?
Are you saying she doesn't swallow?
(Her pills, that is!)
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Wow MPWWHA! Another Master's Class in nuanced snark.
You guys are cool! I'm taking notes this time!
;) :D
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but the really lame part is that Gilead bought the rights to this around 2004 and then discontinued the trials for years and years. If they had brought this to market much earlier then we probably wouldn't be discussing the topic of this thread. But hey, you know that they must be worried about Truvada's patent expiring...
http://www.nasdaq.com/article/gilead-initiates-phase-2-trial-evaluating-gs-7340-for-treatment-of-hiv-20120124-01502
I hate being reminded how my health is dependent upon some cost/benefit analysis at Gilead.
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Another Master's Class in nuanced snark.
;) :D
You are welcome.
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This is a bit worrisome to me as I've been on Atripla for 9 months. As far as I'm aware, my labs have shown normal kidney function, but I've had random and infrequent pain/cramp-like feelings in my sides for the past 6 months or so. Hopefully it's unrelated.
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This is a bit worrisome to me as I've been on Atripla for 9 months. As far as I'm aware, my labs have shown normal kidney function, but I've had random and infrequent pain/cramp-like feelings in my sides for the past 6 months or so. Hopefully it's unrelated.
Monitor your kidney function with your doctor, but the damage done by truvada would be measured in years not months. No need to stress out over this at all.
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the damage done by truvada would be measured in years not months
I disagree, if it's gonna happen, it generally happens at the beginning, in a few months.
I note, reviewing the evidence collected for the new British HIV Association HIV treatment guidelines, that abacavir is equal or slightly worse in terms of bad effect on kidneys within 2 years of starting meds.
- matt
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I have a friend who has been on Atripla since it first came out and said that they just recently discovered he has kidney disease.
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Lovely. One more thing to be worried about.
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I note, reviewing the evidence collected for the new British HIV Association HIV treatment guidelines, that abacavir is equal or slightly worse in terms of bad effect on kidneys within 2 years of starting meds.
I'm not happy about this Newt.
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I'm not happy about this Newt.
So, dressman, since switching to Epzicom what has happened to your kidney function? << I like the dress btw
- matt
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Damn . I have actually had the "protein in urine" show up several times in my labs including the most recent. I guess this is due to the Truvada. I must be one of the lucky ones.
I will ask my doc.
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I had protein in my urine before I went on meds.
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This study has definitely got a lot of people concerned and I just want to reiterate Newt's absolute vs. relative risk comment above. While I appreciate that the UCSF folks went out of their way to generate a "fact sheet (http://www.ucsf.edu/news/2012/02/11507/tenofovir-qa-patients-and-providers)" describing the results, it really didn't go far enough in terms of putting these data into perspective. Like Newt says, the weight of these data depends on your absolute risk of kidney disease going into ARV therapy that uses tenofovir.
This is a bit I added to my own write-up (http://www.aidsmeds.com/articles/hiv_tenofovir_kidney_1667_21898.shtml) of the UCSF Veteran's Health Administration data analysis:
Generally speaking, the absolute risk of kidney disease in a white 40-year-old male with no other risk factors is very low, on the order of 0.2 percent over the next five years of his life, and increases with certain risk factors (e.g., with type-2 diabetes to 1.7 percent, with type-2 diabetes and high blood pressure to 7.2 percent). The 33 percent risk increase associated with tenofovir relates to the original underlying risk, and equates to a 0.066 percent increase in the person without any other risk factors (0.002 X 0.33) and a 2.3 percent increase in the tenofovir user with high blood pressure and diabetes (0.072 X 0.33). So the absolute risk of chronic kidney disease increases to roughly 0.27 percent in a 40-year-old white male without risk factors—still a low absolute risk—and a more moderate 9.5 percent absolute risk in a 40-year-old male with high blood pressure and diabetes.
The numbers are crude, but they speak to what the various risk increases associated with tenofovir really mean. For someone who doesn't have any other risk factors -- blood pressure that doesn't require treatment, healthy body mass index, no diabetes, no family history of kidney disease, etc. -- the 33 percent increase doesn't translate into any profound, whereas it does translate into a potentially meaningful risk for those with risk factors. But most tenofovir-prescribing clinicians already know this and keep a close eye on kidney health labs in the process.
Edited to add: A crude calculator , based on U.K. data, that can be consulted to estimate your underlying absolute risk of chronic kidney disease can be found here: http://www.qkidney.org/index.php (http://www.qkidney.org/index.php)
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I disagree, if it's gonna happen, it generally happens at the beginning, in a few months.
It looks as if the risk of proteinurea increased with time. Whereas the relative risk increase was 72 percent during the first six months of therapy, it increased to 117 percent after three years. The relative risk of everything else seemed to be greatest during the first year of treatment.
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hmmm...but do you think, given how many things can cause it, the protein in your urine even counts? Me, no, a more rigorous test is needed. Maybe you just went to gym, had a kidney infection etc.
The same study showed that abacavir had a significant association with chronic kidney disease, something which clearly didn't get in the press release, although perhaps "Tenfovir and abacavir both associated with chronic kidney disease" is not what people want to read of a morning. << see below
As for the "irreversible" bit that seems to have got in the headlines of lots of write-ups, people who ceased tenofovir had an ongoing increased risk of chronic kidney disease of about 20%, or maybe not, the range of possible results includes a value less than 1, so strictly speaking, especially given the short follow up, the researchers should say they don't know either way. It's annoying this, that not enough follow up has been done for the researchers to comment and then they go comment anyway.
The abacavir association with CKD, and some other associations for ARVS and renal health found in the study is available in this Aidsmap report here (at the bottom):
http://www.aidsmap.com/Tenofovir-associated-with-increased-risk-of-kidney-disease/page/2244707/ (http://www.aidsmap.com/Tenofovir-associated-with-increased-risk-of-kidney-disease/page/2244707/)
- matt
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hmmm...but do you think, given how many things can cause it, the protein in your urine even counts? Me, no, a more rigorous test is needed. Maybe you just went to gym, had a kidney infection etc.
Indeed, though they only classified folks as having proteinurea if there were two consecutive dipstick findings. But to your point, the classifications that depended on eGFR -- definitely the gold standard -- didn't increase over time -- definitely encouraging.
The same study showed that abacavir had a significant association with chronic kidney disease, something which clearly didn't get in the press release, although perhaps "Tenfovir and abacavir both associated with chronic kidney disease" is not what people want to read of a morning.
It looks as if the proteinurea, rapid decline and CKD risk increases with abacavir were 1%, 1% and 7%, respectively, none of which were statistically significant. It does, however, look as if Norvir (both boosting and unboosting doses) significantly increased the risk of proteinurea by 18%, Reyataz significantly increased the risk of rapid decline by 22% and Crixivan significantly increased the risk of CKD by 16%.
TAs for the "irreversible" bit that seems to have got in the headlines of lots of write-ups, people who ceased tenofovir had an ongoing increased risk of chronic kidney disease of about 20%, or maybe not, the range of possible results includes a value less than 1, so strictly speaking, especially given the short follow up, the researchers should say they don't know either way. It's annoying this, that not enough follow up has been done for the researchers to comment and then they go comment anyway.
Excellent point.
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Thanks Tim
The abacavir comment I withdraw. I got so annoyed with different reports I downloaded the paper for a few $s and checked.
The study contained, like, 2% women,
I note that the rapid decline benchmark used in the study was validated in "older adults" (this prob means 65+ as it was done part of a big cardiovascular health study of people aged 65+), so, does it apply to the cohort properly? What is predictive in someone aged 72+ in terms of kidney and heart health is perhaps not for a 35 or 45 year old. I therefore have a big question mark over the rapid decline findings validity. hmmm
- matt
Edited for grammar
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Thanks Tim
The abacavir comment I withdraw. I got so annoyed with different reports I downloaded the paper for a few $s and checked.
The study contained, like, 2% women,
I note that the rapid decline benchmark used in the study was validated in "older adults" (this prob means 65+ as it was done part of a big cardiovascular health study of people aged 65+), so, does it apply to the cohort properly? What is predictive in someone aged 72+ in terms of kidney and heart health is perhaps not for a 35 or 45 year old. I therefore have a big question mark over the rapid decline findings validity. hmmm
- matt
Edited for grammar
Great points Newt- you put my mind at ease with your comments.
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So, dressman, since switching to Epzicom what has happened to your kidney function? << I like the dress btw
- matt
Well, a year ago I was taken of Truvada and my labs from monday show another slight decline in GFr of 68. So I am still waiting on a "rebound" :-\. I have no other risk factors, diabetes, etc... However as MissP pointed out so eloquently above, I do consume a large amount of sodium (which I should not be doing).
the dress is Versace, cigarette by Marlboro.
-W
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Damn . I have actually had the "protein in urine" show up several times in my labs including the most recent. I guess this is due to the Truvada. I must be one of the lucky ones.
I will ask my doc.
He replied that he has known about this and isn't concerned. My GFR is still OK.
I do worry somewhat still, due to my mother and grandfather both having kidney issues.
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However as MissP pointed out so eloquently above, I do consume a large amount of sodium (which I should not be doing).
*cough*
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Just got switched over to Truvada/Isentress from Atripla, so this is an interesting development, the truth is that we do not have long term studies available for most of these medications, in the next six months you might start seeing commercials on late night Cable, "If you have ever taken Truvada or Atripla and now you have kidney damage that was difficult to detect, harder to diagnose and almost impossible to prove in a court of law, call us at 1800 bad deal"
The thing is, your not going to see those commercials, because the group is not going to be a profitable group for lawyers, its not right but that is what will likely happen.
We know that these drugs have a wide array of effects and we have no idea what mixing them with other drugs might do to our bodies over a long period of time.
The one thing you should understand about medicine and science is that nothing is 100 percent, we do not fully understand how the human body even works after 100 years of concentrated study we barely have scratched the surface of the functionality of how our very complex system processes chemicals.
I believe that one of the most important factors of staying healthy may involve something that few doctors are choosing to focus on, and the answer to that may surprise you.
The most important thing about taking Meds, is Water intake.
It can make the difference between toxic levels of chemicals in your body and a mostly harmless excretion of those chemicals.
It would be interesting to learn if in this study they identified the daily water intake, to see which patients were well hydrated, (healthy hydration) and those that were consistently dehydrated if there was a correlation to water intake and the incidence of CDK and or other damages to kidney function, then that might tend to demonstrate that intake was a substantial factor in this discussion of kidney damage.