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Author Topic: atripla and kidney diesease  (Read 3669 times)

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Offline midland moe

  • Member
  • Posts: 39
atripla and kidney diesease
« on: February 22, 2010, 10:29:13 PM »
I just read the article about one of the drugs in atripla being associated with higher risk of kidney disorders...it said there is a 13% greater chance every year that someone uses atripla they will develop kidney dysfucntion...did i read that correctly? so after 1 year you have a 13% greater chance of kidney problems and 2 years 26% ...3 years 39%....4 years 52%....5 years 65%....6 years 78% ....7 years 91% and finally 8 years one would be guranteed kidney failure?
Diagnosed + 4/15/08               VL 570,000  cd4  85
started ATRIPLA 7/20/08         VL 301,757  cd4  45
8/22/08                                 VL       171  cd4  185
11/25/08    undetectable                           cd4  371

03/30/09    undetectable                           cd4  464
07/07/09    undetectable                           cd4  419
12/04/09    undetectable                           cd4  534
        cd4 % 20
04/09/10 undetectable                                cd4  667
         cd4%  22.1
07/16/10   undetectable                              cd4  573
         cd4%  23.8
03/25/11   undetectable                              cd4  655
         cd4%  29.4

Offline Hellraiser

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  • Posts: 4,110
  • Semi-misanthropic
Re: atripla and kidney diesease
« Reply #1 on: February 22, 2010, 10:59:41 PM »
I think it would be 13% of the remaining percentage.... So like.

13% year 1, then 13% of the remaining 87% = 10.5% so...
23.5% year 2
33.4% year 3
41% year 4

etc...

Offline Dsd09

  • Member
  • Posts: 29
Re: atripla and kidney diesease
« Reply #2 on: February 23, 2010, 05:25:01 AM »
Or 13% higher risk than would be for the general population who are not taking Atripla.

I don't actually know what the figures are for the risk of kidney problems in the general population but I would expect it is largely negligible, so I would tend to read that as 13% above that (negiligible) risk.

I know kidney issues are associated with Atripla, and my doctor anyway checks for kidney problems every 3 months, but out of all the side effects I have read from Atripla on this and other forums, I don't recall seeing any threads from people suffering kidney disorders as side effects
07/2009 - Diagnosis
08/2009 - CD4 354 / VL 4700
09/2009 - CD4 286 / VL 3200
10/2009 - CD4 249 / VL n/a - Started Truvada / Sustiva
12/2009 - CD4 318 / VL <40
01/2010 - CD4 316 / VL <40 - Switched Atripla
04/2010 - CD4 370 / VL <40
12/2010 - CD4 342 / VL <40

Offline Assurbanipal

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  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: atripla and kidney diesease
« Reply #3 on: February 23, 2010, 07:20:30 AM »
Here's a writeup of the study.  http://www.aidsmeds.com/articles/renal_kidney_tenofovir_1667_18041.shtml

The writeup says the risk increases 16% per year on a cumulative basis for the drug in Atripla and Truvada.  But as Dad09 points out that is a 16% increase in the risk, NOT the risk itself.

So, as an example, if you were in a group of people that would normally have an (annual) 1% chance of kidney problems, after a year on Atripla you would have a 1.16% chance, after two years a 1.32% chance... it would take a little over 6 years for your likelihood of kidney disease to go up to 2% (assuming the 16% increase was precise.  With only 225 people developing kidney problems in the study one would expect rather wide confidence intervals around the results.)

5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline Inchlingblue

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  • Posts: 3,119
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Re: atripla and kidney diesease
« Reply #4 on: February 23, 2010, 11:05:00 AM »
I'm hoping something better than tenofovir is available soon. When you think about it, there are a huge number of people with HIV on tenofovir since many of those not on Atripla are still taking Truvada as part of their regimen. I take it as part of Isentress/Truvada. Our main options are Truvada, which can lead to kidney problems (and bone loss) or Epzicom, which might lead to heart attacks, woo hoo!

I've read that NSAIDs (Aspirin, Ibuprofen, Naproxen, etc) can exacerbate kidney problems so I'm totally staying away from them. It's probably OK to use them occasionally but I don't even do that. If I absolutely have to take a pain killer I take one acetaminophen, which goes through the liver. I keep even those to a minimum.

Drinking lots of water is also good for kidney health.

Offline Assurbanipal

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  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: atripla and kidney diesease
« Reply #5 on: February 23, 2010, 12:34:01 PM »
... I've read that NSAIDs (Aspirin, Ibuprofen, Naproxen, etc) can exacerbate kidney problems so I'm totally staying away from them. It's probably OK to use them occasionally but I don't even do that. If I absolutely have to take a pain killer I take one acetaminophen, which goes through the liver. I keep even those to a minimum.

Drinking lots of water is also good for kidney health.

You've mentioned the study on NSAIDs a few times, but I'm not certain that staying away from aspirin is necessarily a great strategy.  There is a very significant general population study that shows a daily baby aspirin is highly protective against heart attack risk which is a much more prevalent cause of death than kidney failure.  It is also (as a Non Seroidal Anti Inflammatory Drug) effective against inflammation in general, which we know is one of the conditions that many studies are fingering as a cause of early aging for those with HIV. 

So you might be better off with a daily aspirin (and lots of water) habit.

Me -- I dropped Truvada for Epzicom.  I know I have osteoporosis and am almost certain it was due to Truvada (timing and all that).  And I figure two potential heart attacks in the bush are better than a hip fracture in the hand (to fracture an allegory   ;)).  I was not as worried about the kidneys  (they've only been acting up since I stopped Truvada...)
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline Inchlingblue

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Re: atripla and kidney diesease
« Reply #6 on: February 23, 2010, 12:49:27 PM »
  I was not as worried about the kidneys  (they've only been acting up since I stopped Truvada...)

Did I read that right? Your kidneys started acting up after you stopped Truvada? It's usually the other way around.  Slight loss in glomerular filtration has improved for many people after they stopped Truvada.

I hear you re: the baby aspirin. And since it's such low dose it's probably fine (although I wouldn't do it while on tenofovir). But there are people who pop stronger NSAIDs like tic tacs and I think that could be a problem.

Offline Assurbanipal

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  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: atripla and kidney diesease
« Reply #7 on: February 23, 2010, 03:47:23 PM »
Did I read that right? Your kidneys started acting up after you stopped Truvada? It's usually the other way around.  Slight loss in glomerular filtration has improved for many people after they stopped Truvada.

I hear you re: the baby aspirin. And since it's such low dose it's probably fine (although I wouldn't do it while on tenofovir). But there are people who pop stronger NSAIDs like tic tacs and I think that could be a problem.

One bad set of blood work after a few months on Truvada and then fine for years.  Kidney function was not good on Epzicom/Isentress improved after swapping out Isentress for Prezista / norvir, but latest not good again.  Just lab results on the new regimen so far -- off to the nephrologist in a couple weeks  (he checked me out after the bad  Truvada labs 2-3 years ago and decided I was fine)
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline Tim Horn

  • Member
  • Posts: 800
Re: atripla and kidney diesease
« Reply #8 on: February 23, 2010, 09:40:37 PM »
Hi midland...

As the article illustrates, the relative risk of kidney dysfunction increases by 16 percent per year among those taking regimens containing tenofovir (e.g., Atripla). However, it's important to explain what "relative risk" means, as others have also spelled out here.

A 16 percent increased risk per year means that the risk of developing chronic kidney disease (CKD) increases by 16 percent per year of exposure to tenofovir compared to the same person’s underlying risk of CKD (and never exposed to tenofovir).  

A person being treated with a regimen including tenofovir for two years has a 35 percent -- expressed mathematically as 1.16 x 1.16=1.35 -- increased risk of CKD compared with the same person not being treated with tenofovir. Naturally this has more severe implications for the person if the underlying risk of CKD is already high – e.g. for HIV-positive people suffering from diabetes and hypertension, two widely known risk factors for kidney disease.  

If a person has an underlying absolute risk of 0.50 percent for developing CKD within the next 12  months -- and this is about right for individuals without other risk factors for kidney disease -- one year of tenofovir exposure would, according to the D:A:D study results, lead to a 16 percent relative increase in the absolute risk of CKD – i.e. an absolute risk of 0.58 percent (0.5x1.16).

If a person has an underlying absolute risk of 20 percent for developing CKD in the next 12 months, one year of tenofovir exposure would lead to an increase in this absolute of CKD to 23.2 percent. This is why patients and docs should eye tenofovir carefully -- or at least keep a close eye on their kidney function -- if they have other risk factors for CKD. This isn't new -- most docs have known this for a long time. 

In other words, though we're talking about a notable increase in the relative risk of CKD associated with tenofovir use, this still likely translates into a low ABSOLUTE risk of CKD after one, two, four, six or more years in people without other risk factors. 

Tim Horn
« Last Edit: February 23, 2010, 09:51:10 PM by Tim Horn »

 


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