Sustained eGFR improvement after dapagliflozin in a patient with antiretroviral therapy-related chronic kidney disease.

Abstract

Chronic kidney disease (CKD) is an emerging concern in the aging population of people living with HIV, especially in those with history of nephrotoxic antiretroviral therapy. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown renoprotective effects in various clinical settings, but their utility in patients with antiretroviral-induced kidney impairment remains unexplored. We report the case of a 59-year-old man with well-controlled HIV infection who developed progressive decline in estimated glomerular filtration rate (eGFR, mL/min/1.73 m²) over 15 years of taking antiretroviral therapy (ΔeGFR - 2.3 mL/min/1.73 m² per year), including 8 years of tenofovir disoproxil fumarate (TDF) intake. After discontinuation of TDF and its successor drug, the eGFR stabilized at approximately 52 for approximately 4 years. The SGLT2 inhibitor dapagliflozin was started to prevent renal decline. Subsequently, the eGFR increased to 57.3 after 3 months and 60.2 after 6 months, then was maintained at approximately 57 thereafter. After dapagliflozin initiation, the overall eGFR slope was + 1.2 mL/min/1.73 m² per year. To the best of our knowledge, this was the first report demonstrating improvement in eGFR slope after SGLT2 inhibitor use in a patient with antiretroviral-associated renal impairment. This highlighted the potential role of SGLT2 inhibitors in mitigating CKD progression in people living with HIV.