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Author Topic: Tenofovir associated with significant Kidney Damage  (Read 9525 times)

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Offline buginme2

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Tenofovir associated with significant Kidney Damage
« on: February 11, 2012, 01:37:07 PM »
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?
Don't be fancy, just get dancey

Offline newt

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Re: Tenofovir associated with significant Kidney Damage
« Reply #1 on: February 11, 2012, 01:51:04 PM »
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
"The object is to be a well patient, not a good patient"

Offline buginme2

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Re: Tenofovir associated with significant Kidney Damage
« Reply #2 on: February 11, 2012, 01:56:53 PM »
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.
Don't be fancy, just get dancey

Offline newt

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Re: Tenofovir associated with significant Kidney Damage
« Reply #3 on: February 11, 2012, 02:02:50 PM »
Quote
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
"The object is to be a well patient, not a good patient"

Offline buginme2

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Re: Tenofovir associated with significant Kidney Damage
« Reply #4 on: February 11, 2012, 02:06:39 PM »
Thanks!
Don't be fancy, just get dancey

Offline mikeyb39

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Re: Tenofovir associated with significant Kidney Damage
« Reply #5 on: February 11, 2012, 05:36:17 PM »
I guess that supports another good benefit of dropping my viread...
11/02/2010  cd4-251, vl-591000
12/09/2010  started Atripla
02/18/2011  cd4-425, vl-800
06/10/2011  cd4-447, vl-70
10/10/2011  cd4-666, vl-80
01/05/2012  swiched med (prezista,norvir ,isentress, )
02/10/2012  cd4-733, vl-UD  Viread removed
06/10/2012  cd4-614, vl-UD
12/14/2012  cd4-764, vl-UD
09/01/2013  cd4-785, vl-UD
03/06/2014. cd4- 1078, VL-UD
09/05/2014  cd4-850 , VL-UD

Offline WillyWump

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Re: Tenofovir associated with significant Kidney Damage
« Reply #6 on: February 11, 2012, 06:02:22 PM »
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
POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline Hellraiser

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  • Semi-misanthropic
Re: Tenofovir associated with significant Kidney Damage
« Reply #7 on: February 11, 2012, 07:19:38 PM »
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*


Offline denb45

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  • "1987 Classic Old School POZ+"
Re: Tenofovir associated with significant Kidney Damage
« Reply #8 on: February 11, 2012, 07:39:27 PM »
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....
« Last Edit: February 11, 2012, 07:41:34 PM by denb45 »
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline Miss Philicia

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  • celebrity poster, faker & poser
Re: Tenofovir associated with significant Kidney Damage
« Reply #9 on: February 11, 2012, 07:47:56 PM »
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.
"Iíve slept with enough men to know that Iím not gay"

Offline denb45

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  • "1987 Classic Old School POZ+"
Re: Tenofovir associated with significant Kidney Damage
« Reply #10 on: February 11, 2012, 07:54:34 PM »
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  ::)
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline WillyWump

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Re: Tenofovir associated with significant Kidney Damage
« Reply #11 on: February 11, 2012, 10:16:21 PM »
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
POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline Ann

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    • Num is sum qui mentiar tibi?
Re: Tenofovir associated with significant Kidney Damage
« Reply #12 on: February 12, 2012, 07:01:57 AM »
^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!
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline J.R.E.

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  • Posts: 7,251
  • Joined Dec-2003 Living positive, since 1985.
Re: Tenofovir associated with significant Kidney Damage
« Reply #13 on: February 12, 2012, 10:33:08 AM »

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

Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 25 mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


Diagnosed positive in 1985,.. In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started on  HAART on October 24th, 2003.

 As of 8/25/14,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline denb45

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  • "1987 Classic Old School POZ+"
Re: Tenofovir associated with significant Kidney Damage
« Reply #14 on: February 12, 2012, 10:45:19 AM »
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  ::) 
« Last Edit: February 12, 2012, 10:49:22 AM by denb45 »
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline Miss Philicia

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  • celebrity poster, faker & poser
Re: Tenofovir associated with significant Kidney Damage
« Reply #15 on: February 12, 2012, 10:48:15 AM »
fyi, and I mentioned this elsewhere recently, but Gilead will hopefully be coming out with a "low dose pro-drug" 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
"Iíve slept with enough men to know that Iím not gay"

Offline Miss Philicia

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  • Posts: 24,418
  • celebrity poster, faker & poser
Re: Tenofovir associated with significant Kidney Damage
« Reply #16 on: February 12, 2012, 10:49:46 AM »
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 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!
"Iíve slept with enough men to know that Iím not gay"

Offline WillyWump

  • Member
  • Posts: 7,235
Re: Tenofovir associated with significant Kidney Damage
« Reply #17 on: February 12, 2012, 11:58:53 AM »

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  ;)
POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline Miss Philicia

  • Member
  • Posts: 24,418
  • celebrity poster, faker & poser
Re: Tenofovir associated with significant Kidney Damage
« Reply #18 on: February 12, 2012, 12:53:39 PM »

Hellraiser: "No, I dont like the way it tastes"

That pretty much sums her up, doesn't it?
"Iíve slept with enough men to know that Iím not gay"

Offline Ann

  • Administrator
  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Tenofovir associated with significant Kidney Damage
« Reply #19 on: February 12, 2012, 01:31:59 PM »
That pretty much sums her up, doesn't it?

Are you saying she doesn't swallow?

(Her pills, that is!)
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline OneTampa

  • Member
  • Posts: 2,295
  • "Butterflies are free."
Re: Tenofovir associated with significant Kidney Damage
« Reply #20 on: February 12, 2012, 05:03:46 PM »
Wow MPWWHA!  Another Master's Class in nuanced snark.

You guys are cool!  I'm taking notes this time!

 ;)  :D
« Last Edit: February 12, 2012, 05:23:23 PM by OneTampa »
"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaŪto frito."

Offline buginme2

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  • Posts: 3,201
Re: Tenofovir associated with significant Kidney Damage
« Reply #21 on: February 12, 2012, 06:41:46 PM »
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.   

Don't be fancy, just get dancey

Offline WillyWump

  • Member
  • Posts: 7,235
Re: Tenofovir associated with significant Kidney Damage
« Reply #22 on: February 12, 2012, 07:42:27 PM »
Another Master's Class in nuanced snark.

 ;)  :D

You are welcome.
POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline dpb

  • Member
  • Posts: 89
Re: Tenofovir associated with significant Kidney Damage
« Reply #23 on: February 13, 2012, 04:32:29 PM »
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.
Date        CD4    %    VL
1/15/11    Diagnosed
3/1/11    525    18    168,518
5/12/11    558    16    331,791
5/16/11    Started Atripla
5/31/11    NA    NA    1,200
6/15/11    721    21    330
7/15/11    649    23    231
8/15/11    569    25    UD
11/17/11  752    26    UD
3/1/12    634    27    UD
7/2/12    594    26    UD
2/13       676    30    UD
9/13       662    31    UD

Offline Hellraiser

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  • Posts: 4,140
  • Semi-misanthropic
Re: Tenofovir associated with significant Kidney Damage
« Reply #24 on: February 14, 2012, 03:09:12 PM »
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.

Offline newt

  • Member
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  • the one and original newt
Re: Tenofovir associated with significant Kidney Damage
« Reply #25 on: February 14, 2012, 04:04:10 PM »
Quote
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
"The object is to be a well patient, not a good patient"

Offline freaky_dream

  • Member
  • Posts: 132
  • mmm
Re: Tenofovir associated with significant Kidney Damage
« Reply #26 on: February 14, 2012, 04:42:36 PM »
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.

Offline dpb

  • Member
  • Posts: 89
Re: Tenofovir associated with significant Kidney Damage
« Reply #27 on: February 14, 2012, 05:18:31 PM »
Lovely.  One more thing to be worried about.
Date        CD4    %    VL
1/15/11    Diagnosed
3/1/11    525    18    168,518
5/12/11    558    16    331,791
5/16/11    Started Atripla
5/31/11    NA    NA    1,200
6/15/11    721    21    330
7/15/11    649    23    231
8/15/11    569    25    UD
11/17/11  752    26    UD
3/1/12    634    27    UD
7/2/12    594    26    UD
2/13       676    30    UD
9/13       662    31    UD

Offline WillyWump

  • Member
  • Posts: 7,235
Re: Tenofovir associated with significant Kidney Damage
« Reply #28 on: February 14, 2012, 06:14:53 PM »


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.

POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline newt

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  • the one and original newt
Re: Tenofovir associated with significant Kidney Damage
« Reply #29 on: February 14, 2012, 07:27:57 PM »
Quote
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
"The object is to be a well patient, not a good patient"

Offline madbrain

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    • My personal site
Re: Tenofovir associated with significant Kidney Damage
« Reply #30 on: February 14, 2012, 11:22:10 PM »
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.

Offline Hellraiser

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Re: Tenofovir associated with significant Kidney Damage
« Reply #31 on: February 14, 2012, 11:36:07 PM »
I had protein in my urine before I went on meds.

Offline Tim Horn

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  • Posts: 799
Re: Tenofovir associated with significant Kidney Damage
« Reply #32 on: February 15, 2012, 08:25:44 AM »
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" 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 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 factorsóstill a low absolute riskóand 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
« Last Edit: February 15, 2012, 09:25:26 AM by Tim Horn »

Offline Tim Horn

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Re: Tenofovir associated with significant Kidney Damage
« Reply #33 on: February 15, 2012, 09:11:10 AM »
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.
« Last Edit: February 15, 2012, 11:32:30 AM by Tim Horn »

Offline newt

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Re: Tenofovir associated with significant Kidney Damage
« Reply #34 on: February 15, 2012, 12:23:32 PM »
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/

- matt
« Last Edit: February 15, 2012, 01:26:46 PM by newt »
"The object is to be a well patient, not a good patient"

Offline Tim Horn

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Re: Tenofovir associated with significant Kidney Damage
« Reply #35 on: February 15, 2012, 12:45:12 PM »
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.


« Last Edit: February 15, 2012, 12:47:19 PM by Tim Horn »

Offline newt

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Re: Tenofovir associated with significant Kidney Damage
« Reply #36 on: February 15, 2012, 01:19:29 PM »
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
« Last Edit: February 15, 2012, 03:52:23 PM by newt »
"The object is to be a well patient, not a good patient"

Offline sunzidog

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Re: Tenofovir associated with significant Kidney Damage
« Reply #37 on: February 15, 2012, 05:31:10 PM »
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.
« Last Edit: February 15, 2012, 05:33:40 PM by sunzidog »
Infected 01/02/07
03/07: VL<3800 CD4s 506 (Started Atripla)
04/07: VL<500 CD4s 585
05/07: VL<500 CD4s 606
07/07: VL<50 CD4s 1000

Offline WillyWump

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Re: Tenofovir associated with significant Kidney Damage
« Reply #38 on: February 15, 2012, 05:56:19 PM »
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
POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline madbrain

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Re: Tenofovir associated with significant Kidney Damage
« Reply #39 on: February 15, 2012, 07:55:23 PM »
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.

Offline Miss Philicia

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Re: Tenofovir associated with significant Kidney Damage
« Reply #40 on: February 16, 2012, 12:28:55 AM »
However as MissP pointed out so eloquently above, I do consume a large amount of sodium (which I should not be doing).

*cough*
"Iíve slept with enough men to know that Iím not gay"

Offline justpoz

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Re: Tenofovir associated with significant Kidney Damage
« Reply #41 on: February 16, 2012, 06:48:38 PM »
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.
diag 08  vl 60,000 cd4 360
started atripla, 708
could not afford cost of meds.
stopped atripla 808 started atripla 109  vl 90,000 cd4 250 | 209 vl undect, cd4 275

Changed meds Truvada 200-300
Isentress 400 | 0312  vl und  cd4 550
snip
1212  vl und  cd4 625
0113  vl und  cd4 675
12/13 vl und  cd4 720

Feb 2014, insurance blue cross blue shield, increases co-pay from 120.00 to 970.00, tier 5, 33 percent of retail prices.

Cannot obtain any patient assistance, the AFA is a serious threat to patients with HIV. 

Unable to afford to purchase medications.
tired of fighting to stay alive.

March 4, 2014, VL, 161,000 cd4 400
Terrified but helpless to do anything about it.

 


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