Tenofovir obat HIV AIDS ini, ternjata meningkatkan resiko gagal ginjal, Kenapa ANDA harus bayar mahal-mahal, sekalipun gratis, buat apa kalau akhirnya ginjal rusak? Gunakan saja VCO, aman murah, dan mudah didapat, serta dapat dibuat sendiri.Patients who take one of the most widely prescribed drugs to treat HIV infection increase their risk of kidney damage by up to 34 percent every year they take the medication, according to a study of more than 10,000 HIV-positive veterans. The study, by the San Francisco VA Medical Center and published online earlier this month, is one of the largest to address the long-term risk of tenofovir, an antiretroviral drug that is taken daily, usually in a single pill combined with other drugs.
Doctors have long known that antiretroviral drugs carried some risk of kidney damage, but how much - and whether that damage is caused by a particular drug or combination of drugs, or by the HIV infection itself - has been the source of much debate.
And it's a debate that is likely to become more heated. For many HIV-infected patients, the benefits of taking tenofovir and preventing full-blown AIDS will far outweigh the risk of long-term kidney damage. But some public health experts have begun to promote the drug for healthy individuals after recent research showed that tenofovir could prevent HIV infection.
With the new findings, the pros and cons become a little murkier, researchers say.
"You're willing to sacrifice a little bit of long-term kidney damage when it's keeping you alive in the short-term," said Dr. Michael Shlipak, chief of general internal medicine at the VA medical center and an author of the study. "But as HIV becomes a longer and longer chronic disease, people may be on these drugs for 20 years, and that risk is really going to add up.
"Then you take it to people who don't even have HIV, you're talking all risk and potentially marginal benefit."
No one is recommending that patients stop taking tenofovir and other antiretroviral drugs or that doctors should not prescribe it. Shlipak and other HIV/AIDS experts noted that those medications have been remarkably successful in treating HIV. In the United States, many patients are living years and even decades with their infection in check.
As a preventative
Researchers who have been looking at tenofovir to prevent HIV infection note that studies so far have shown very little increased risk of kidney damage in people who are otherwise healthy.
The most recent prevention study, involving 2,500 men who did not have HIV, was led by scientists at UCSF and the Gladstone Institutes. Only a handful of participants showed signs of kidney damage, and in all of their cases those signs went away once the drug was stopped.
San Francisco public health officials are developing a project, to be launched sometime this year, to offer tenofovir widely to uninfected people for HIV prevention. The goal is to study how best to deliver tenofovir to the community and how useful it is for prevention. But researchers will also closely monitor the drug's effect on kidney function, said Dr. Albert Liu, director of HIV prevention intervention studies at the San Francisco Department of Public Health.
"The (VA) study was done in HIV-positive patients, and we don't know whether the findings apply to HIV-uninfected people who are taking tenofovir for prevention," Liu said.
Researchers with the VA study said they did their best to separate the effects of the drug on the kidneys from the effects on organs from the HIV infection or other diseases. Shlipak said he's confident that tenofovir alone harms the kidneys, although the damage is even more serious in people who are HIV-positive.
Large VA study
The VA study, which was published online in the journal AIDS, involved 10,841 HIV-infected men and women who started antiretroviral therapy from 1997 to 2007; 4,303 of those patients took tenofovir at some point.
Researchers looked at three symptoms of kidney damage - protein in the urine, rapid decline in kidney function and chronic kidney disease - and compared patients who had never taken tenofovir with those who had.
They found that among those who took the drug, the risk of developing one of those signs of kidney damage increased by 11 to 34 percent each year, and their risk remained elevated even after they stopped taking it.
Even with that increased risk, the overall chance of long-term kidney damage was fairly low. For example, participants who took tenofovir had a 2 percent risk of developing chronic kidney disease after one year on the drug, compared with 1 percent for those who didn't.
"Does this mean that all patients on tenofovir need to be stopped? No," said Dr. Michael Horberg, director of HIV/AIDS at Kaiser Permanente. "What it does mean is you need to be monitoring these patients closely. You need to be checking kidney function, and if the signs are trending toward worsening function, consider alternatives."
Douglas Sharpe, a VA patient who took tenofovir for 10 years until his doctor switched him to a different medication in 2009, said he never knew the drug could have damaged his kidneys - but even knowing that, he would have taken it anyway.
"At the time it was a saving grace," said Sharpe, 67, whose kidneys are fine. "I have no regrets taking it."
Erin Allday is a San Francisco Chronicle staff writer. eallday@sfchronicle.com
This article appeared on page A - 1 of the San Francisco Chronicle
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