Key Decisions in HIV Care: Renal and Hepatic Considerations in Older PWH

In this episode from the series “Key Decisions in HIV Care,” Jonathan Appelbaum, MD, FACP, AAHIVS, and Jens D. Lundgren, MD, DMSc, discuss important considerations for antiretroviral therapy (ART) use in older patients with renal and hepatic impairment.

• European AIDS Clinical Society guideline screening recommendations for kidney disease in people with HIV
• Antiretroviral dose adjustment recommendations based on estimated glomerular filtration rate
• Data on the use of full-dose lamivudine with renal impairment
• Data on the use of 2-drug nucleos(t)ide reverse-transcriptase inhibitor–sparing ART regimens, including GEMINI-1 and -2, TANGO, and SALSA for dolutegravir/lamivudine; SWORD-1 and -2 for dolutegravir/lamivudine; and ATLAS and FLAIR for long-acting cabotegravir plus rilpivirine
• US Department of Health and Human Services recommendations on the use of ART agents with hepatic impairment
• Recommendations from the American Gastroenterological Association on screening and diagnosis of nonalcoholic fatty liver disease (NAFLD)
• Prevalence of NAFLD, nonalcoholic steatohepatitis, and liver fibrosis in people with HIV
• Overlapping risk factors between HIV and NAFLD