A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus\n(HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate\n(TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine\nand dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment\nand ongoing monitoring of renal function is an important part of routine management of patients with HIV.\nGiven the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring\ncould be performed in Australian patients on ART regimens, especially those involving TDF. A group of\nnephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical\nand reasonable renal management strategies for patients particularly those on TDF-based combination regimens\n(in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group\nconsidered which investigations should be performed as part of routine practice, their frequency, and when\nspecialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with\nplasma phosphate and an assessment of urinary protein (rather than albumin) and glucose.\nHere we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g.\ncobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this\nvalue used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly\nthereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment\nshould be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing protocol\nmay be logical.
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