Question
Is TLD safe for kidneys?
1 May 2024. Related: All topics, Side effects.
Hi. My question has to do with HIV meds and the kidneys. What are the chances of developing kidney related issues/problems if on HIV medication and what can one do. Am very worried. Am on TLD. Thank you
Answer
Hi, how are you doing?
Have you had your kidneys tested? Do you know your creatinine clearance and eGFR? or know if you have any problems with your kidneys?
In people with healthy kidneys, TLD rarely causes problems with kidneys. You can help prevent this by avoiding certain medications (that your doctor/pharmacist) and making sure you are drinking plenty of water.
If you have known kidney problems, TLD can have a higher risk of damage but with regular monitoring it is still safe to continue with TLD and if problems do occur (which is rare), alternative treatments can be offered.
TLD is a preferred choice of medication due to a limited side effect profile and is generally well tolerated by people.
Josh.
Hello Mikhael and thanks for getting in touch.
I know it sounds complicated so I will try to break it down and explain:
1. Dolutegravir – Lamivudine is a really good combination drug and we have had a long experience with it in the West.
It is recommended as one of the first line choices nowadays (in the European guidelines https://www.eacsociety.org/media/guidelines-12.0.pdf)
So please do not worry, you will be safe on this regimen and you might even experience less side effects.
You can read more here:
https://i-base.info/guides/14379
2. Your kidney function is not worryingly low. It dropped and your doctor was right to look into it.
It is not a reason for concern though.
However, taking creatine supplements interferes with the tests showing lowered kidney function.
This is not harmful to the kidneys. If you stop the supplements 1-2 weeks before you have tests, everything will go back to normal.
That’s why your partner’s kidney function returned to normal range when he stopped the creatine supplements.
Moreover, try to avoid NSAIDs like aspirin, ibuprofen, etc. before having blood tests as they also interfere with the readings.
Finally, the best thing you can do for your kidneys is to drink 2 litres of water per day at least.
Hi.. my doctor switched me and my partner from TLE to TLD in march. We tested 3 months later and everything looks great except eGFR which was 78 and 72 for my partner and me.
We redid the egfr using cystatine c and creatinine. My partner got back 108 with cystatine c and 67 with creatine. I got back with 77 and 78 each.
My doctor switched me now to dolutegravir and 2 lamivudine while my partner is still with TLD.
My question is it safe with 2 regiments ? Will the viral load bounce back ? And will it help increase my eGFR ? My internist thinks it is AKI for my kidney and hopefully it will return to 90 as before.
Is my 35 yr old partner alright with the cystatine and creatinine levels he has ?
I am so confused. We did not have this problem with TLE, albeit my cd4 doubled with TLD. Please advise.
Hello Mavhandu and thanks for getting in touch.
Please do not worry.
Dolutegravir increases the serum creatinine which makes the eGFR show a drop in the numbers.
However, dolutegravir is safe for the kidneys and doesn’t harm them (you will see this in literature as “not nephrotoxic”).
Tenoforvir though, which is included in both treatments you are and have been on can cause kidney problems in the long run.
At present your kidney function is still good – no need for immediate concern.
It is a good idea to have a discussion about this with your doctor as they might be able to offer you a different combination of medication.
TLD is a better medication than TLE having less side effects and toxicities.
You can read more here:
https://i-base.info/guides/category/arvs
Additionally, make sure you drink at least 2 litres of water per day.
This will help your kidneys flush out the medication, limiting their effect on the kidneys to some degree.
I have been switched to TLD tablets from TLE. After 6 months from since taking TLD, my eGFR dropped from 69 to 57. Should I revert to TLE or the drop could have been caused by something else?
Hi Emmanuel – thanks for your comment :)
Thanks Jose, I have started taking it at night. I forgot to ask this: I was on Effavirenz before moving to TLD not because of any reason but they said the supply is only on TLD. But due to the side effect I have experienced over the years that’s why I am deciding to go back to TLE.
Hope it is safe? My count is undectected
Hi Emmanuel, most people find efavirenz is better before you go to bed. They you can slepp through the side effects that can change your moods. A few people say they can take if during the day, but not many.
I have gotten the effavirenz combination, can I take it in the morning or I should revert to night
Hi Emmanuel, yes it is safe to switch. What type of kidney issues are you having?
Thank you for your answer, I am actually having signs of kidney issues and I am on TLD. Is it safe to switch to efavirenz-LT.