. Author manuscript; available in PMC: 2019 Mar 1.

Published in final edited form as: Kidney Int. 2018 Feb 3;93(3):545–559. doi: 10.1016/j.kint.2017.11.007

Table 4.

Recommendations for management of CKD risk factors in HIV-positive individuals

Risk Factor	Recommendations
Hypertension
Non - proteinuric	• Target systolic blood pressure ≤140 mmHg¹¹⁶
Proteinuric	• Target systolic blood pressure ≤130 mmHg¹¹⁶ • Preferred antihypertensive: ACE inhibitors or angiotensin receptor blockers¹¹⁶
Diabetes mellitus	• Target hemoglobin A1c ~7%^*¹⁰³
Hepatitis B virus co - infection	• Treat per existing guidelines^{118, 121} •TAF may be used in patients with eGFR ≥ 30 ml/min/1.73 m².¹⁵⁴ • Where TAF is unavailable or in patients with eGFR < 30 ml/min/1.73 m², dose-adjusted TDF or entecavir may be considered.
Hepatitis C virus co - infection	• Treatment per existing guidelines^{120, 155} • In patients with HCV genotypes 1 or 4 and CKD G4/5, ribavirin-free grazoprevir and elbasvir regimens may be effective.^156–158 • In patients with genotypes 2, 3, 5 or 6, sofosbuvir-based regimens are required; however, sofosbuvir-based regimens should be avoided or alternate-day sofosbuvir dosing should be considered in patients with eGFR <30 ml/min/1.73 m².^159–161 In addition, the combination of ledipasvir/sofosbuvir with TDF should be avoided.

Note: Hemoglobin A1c may underestimate glycemia in HIV-positive individuals.^{162, 163}

ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; eGFR, estimated glomerular filtration rate; HCV, hepatitis C;TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate