Estudio comparativo a largo plazo de la función renal en pacientes con infección VIH tratados con tenofovir disoproxil fumarato

Abstract

The first cases described and related to the human immunodeficiency virus (HIV) date back to 1981, but it wasn’t until 1983 that the virus was first isolated by Barré- Sinoussi and Montagner. Since the early 80’s it is estimated that 60 people have been infected and at least 25 million related deaths have occurred. This places the HIV as one of the most important worldwide pandemics in human history. The natural history of HIV infection has greatly changed over the last three decades, mainly due to the introduction of what was called the HAART (Highly Active Antiretroviral Therapy) in 1996. HAART has dramatically improved life expectancy of patients infected with HIV, and nowadays most of these people will have a life expectancy close (if not the same) to that of people without HIV infection. However, during its history, HAART regimens have been associated with different types and levels of toxicity. Because HIV prompts a chronic infection that still has no cure, HAART must be taken over a lifetime and thus drug toxicity concerns gain relevance in the short and long term care of HIV patients. On the other hand, the control of AIDS-related morbimortality is being translated into an ageing of HIV infected population, which is thought to be accelerated by the persistent inflammation and immune activation related to the chronicity of the HIV infection. As a consequence, other non-AIDS related diseases such as cardiovascular diseases and renal impairment are emerging as a growing burden of morbimortality in patients with HIV infection. At present, tenofovir disoproxil fumarate (TDF) is recommended as a first line drug in the backbone of the anti-retroviral treatment (ART) in naive patients, and is part of most of the initial ART in this population. It has shown a good safety profile in large randomized controlled trials. However, since its approval in the year 2000, there have been many clinical reports, observational studies and, to a lesser extent, clinical trials that show a potential role of TDF in provoking different grades of reductions in the estimated glomerular filtration (EGF), as well as varying sorts and grades of kidney damage...