Our findings were similar when a number of alternative definitions of eGFR decrease were

used and are consistent with those of other recent studies showing that patients receiving tenofovir in combination with PI/r-based regimens had an increased decline in renal function compared with those receiving tenofovir/NNRTI or non-tenofovir-treated IWR-1 in vitro individuals [15–33]. This study has several limitations. eGFR values were not adjusted for potential exposure to possibly nephrotoxic drugs such as aminoglycosides or drugs used for the treatment of opportunistic infections. The MDRD equation has not been independently validated in populations of HIV-infected patients and our analysis was not repeated using alternative methods of estimation (e.g. the Cockcroft–Gault, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Mayo Quadratic

or Schwartz formulas) [43–45]. Moreover, because data were collected in an observational setting, patients were not randomized to treatment and channelling bias cannot be ruled out. In conclusion, our study shows that, in our study population of untreated HIV-infected patients, moderate renal dysfunction (eGFR<90 mL/min/1.73 m2) is relatively frequent (25%) while severe impairment (eGFR<60 mL/min/1.73 m2) is rare (3%). Moreover, we provide further click here evidence supporting the hypothesis that current use of specific antiretrovirals (didanosine-, tenofovir- and PI-containing therapies) may result in an increased risk of eGFR decline in HIV-infected patients beginning cART. For some of the drug combinations studied, the association with the risk of developing the outcome was of similar strength to that seen for older age. Although our definition of eGFR decline (≥20% decline from pre-therapy levels) Sitaxentan might be regarded as a relatively small decrease, we consider it paramount to monitor renal function in HIV-infected patients receiving or not receiving ART, as the progressive worsening of renal function may in the long

term reach a clinically significant level. We also consider close monitoring to be important in view of the fact that (i) newly diagnosed HIV-infected subjects tend to be older and (ii) HIV-infected populations are ageing as the use of ART has led to patients living longer and thus being at increased risk of metabolic and cardiovascular complications. Conflict of interest statement: No member of the ICONA Foundation Study has any financial or personal relationships with people or organizations that could inappropriately influence this work, although most members of the group have, at some stage in the past, received funding from a variety of pharmaceutical companies for research, travel grants, speaking engagements or consultancy fees.