CKD Non-ART Causes — SCE Infectious Diseases MCQ

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ModerateHIV MedicineCKD Non-ART CausesSCE Infectious Diseases

A 40-year-old man with HIV (CD4 550, VL <50 on ART) develops chronic kidney disease. His eGFR declines from 90 to 45 mL/min over 2 years. He is on Tenofovir AF/Emtricitabine/Dolutegravir. Urine shows no proteinuria or glycosuria. Phosphate is normal. What is the most likely cause of his CKD?

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Correct answer: B — Traditional CKD risk factors (diabetes, hypertension, ageing) rather than ART-related nephrotoxicity — TAF has minimal renal toxicity; assess for non-ART causes

TAF has significantly less renal toxicity than TDF. In the absence of tubular dysfunction features (proteinuria, glycosuria, hypophosphataemia — which would suggest Fanconi syndrome from TDF), progressive CKD in a well-controlled HIV patient on TAF is most likely from traditional CKD risk factors: hypertension, diabetes, obesity, ageing, APOL1 risk variants (in patients of African ancestry). The clinician should investigate non-ART causes rather than attributing CKD to TAF. HIV itself (even when suppressed) contributes to accelerated renal ageing through chronic inflammation.

Reference: BHIVA 2025 – ART guidelines (renal section); NICE NG203 2021 – CKD; EACS 2025