Improved kidney function with switch from atazanavir or lopinavir to darunavir


In the UK CHIC cohort study 1430 patients who switched from either atazanavir or lopinavir containing antiretroviral treatment combinations to darunavir were evaluated for changes in kidney function. At least 6 months of therapy pre and post switch was required for inclusion. By comparing at least two eGFR (estimated glomerular filtration rate) pre and post switch “eGFR slopes” were estimated before and after treatment switch. A small annual decline in eGFR was observed before switch. Mean eGFR
slopes for atazanavir was -0.84 ml/min per 1.73 m2 per year compared to +1.23 after switching to darunavir. For lopinavir the corresponding figures were -0.57 and +0.62. The differences were highly statistically significant and remained significant if patients who also stopped tenofovir (TDF) treatment were excluded from the analysis. Also a subgroup of patients who had a rapid eGFR decline (>3ml/year) improved markedly after switching to darunavir.

Jose et al. AIDS 2017;31:485-492

Comment: With an aging HIV population declining kidney function is becoming more common. Increased incidence of kidney stones has been reported in patients on atazanavir and it seems
reasonable to use atazanavir with caution in patients with declining kidney function.