6
Treatment
Management
Î IDSA recommends that clinicians prescribe ART and encourage
persistence with therapy in HIV-infected patients who have CKD or
ESRD, as ART reduces mortality but is underused in this patient
population (S-M).
Î IDSA recommends that clinicians use either the CKD Epidemiology
Collaboration (CKD-EPI) creatinine equation to estimate GFR or the
Cockcroft-Gault equation to estimate creatinine clearance (CrCl) when
dosing antiretroviral drugs or other drugs that require reduced doses in
patients with reduced kidney function (S-M).
Î IDSA recommends that patients with biopsy-confirmed or clinically
suspected HIV-associated nephropathy (HIVAN) receive ART to reduce
the risk of progression to ESRD (S-M).
Î In patients infected with HIV who have a GFR <60 mL/min/1.73 m
2
,
IDSA recommends avoiding tenofovir and other potential nephrotoxic
drugs (eg, nonsteroidal anti-inflammatory drugs) when feasible (S-L).
Î In tenofovir-treated patients who experience a confirmed GFR
decline by >25% from baseline and to a level <60 mL/min/1.73 m
2
,
IDSA recommends substituting alternative antiretroviral drug(s) for
tenofovir, particularly in those with evidence of proximal tubular
dysfunction (S-L).
Cardiovascular Drugs
Î IDSA recommends using angiotensin-converting enzyme (ACE)
inhibitors or angiotensin II receptor blockers (ARBs), when clinically
feasible, in patients infected with HIV who have confirmed or suspected
HIVAN or clinically significant albuminuria (eg, >30 mg/day in diabetic
patients; >300 mg/day in nondiabetic patients) (S-H).
Î IDSA recommends that HIV-infected individuals with pre-ESRD CKD be
treated with statins to prevent cardiovascular disease as appropriate
for persons in the highest cardiovascular risk group (eg, >7.5% 10-year
risk of cardiovascular disease) (S-H).
Î IDSA suggests that clinicians consider prescribing aspirin
(75-100 mg/day) to prevent cardiovascular disease in HIV-infected
individuals with CKD; however, the benefit of aspirin should be
balanced against the individual's risk of bleeding (W-H).
Blood Pressure
Î IDSA recommends a target blood pressure of <140/90 mm Hg in
HIV-infected patients who have CKD with normal to mildly increased
albuminuria (eg, <30 mg/day or equivalent) (S-M).
