Sometimes people are faced with choosing the lesser of two evils- ask anyone that has voted in an election, and it’ll prove my point. But, what about when it comes to your health? Would you be comfortable taking a medication that you are given to treat a condition you have, knowing that you would ultimately have some pretty severe side effects? I’m not sure many would feel comfortable in doing so, unless it was a life or death situation. A recent study unfortunately shows people making this kind of decision all the time.
The study, is proving that 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 the study.
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.
The study involved over 10,000 HIV-positive male and female veterans, The Chronicle reported. They had all started antiretroviral therapy from 1997 to 2007; 4,303 of those patients took Tenofovir at some point. According to the study, the risk of developing a symptom of kidney damage – protein in the urine, rapid decline in kidney function and chronic kidney disease – increased by 11 to 34 percent each year, and patients’ risk remained elevated even after they stopped taking it.
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.
“Does this mean that all patients on tenofovir need to be stopped? No,” Dr. Horberg stated. “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.”
For people with HIV, the benefits of Tenofovir – preventing the development of AIDS – mostly likely still outweigh its risk, the Chronicle said. But the new findings could dampen enthusiasm for tenofovir as an HIV preventative, though more research is needed.