Managing chronic kidney disease in the older adults living with HIV

Purpose of review HIV replication and immunodeficiency are important risk factors for chronic kidney disease (CKD). Widespread use of antiretrovirals that may affect kidney function underscores the need for monitoring kidney function, allowing early detection of drug-induced kidney injury and identification of patients who may benefit from antiretroviral therapy switches. Recent findings Several cohorts have reported an increased incidence of CKD with tenofovir [tenofovir disoproxil fumarate (TDF)], atazanavir, and lopinavir, and CKD risk scores have been developed to identify those most at risk of kidney disease progression while receiving these agents. Recent data suggest that TDF discontinuation and substitution of atazanavir or lopinavir with darunavir may stabilize or improve renal function. Tenofovir alafenamide (TAF) is a new tenofovir formulation with minimal effect on renal tubular function. Patients with preserved or mild-moderately impaired renal function who switched from TDF to TAF-containing regimens experienced rapid and sustained improvement in proteinuria and stable renal function, suggesting that TAF will be the preferred tenofovir formulation for patients with CKD and those at increased risk of developing CKD. Summary Suppression of HIV replication and antiretroviral switches away from TDF and atazanavir are important measures to maintain kidney function and reduce CKD risk in older adults living with HIV.