3 per 1000 person-years, with almost half of those who developed renal stones having eGFR <60 at the time of ATV initiation . The nephrotoxic potential
of both TDF and ATV is low in patients with normal renal function. However, in patients with CKD and impaired renal function (eGFR <75 mL/min/1.73m2), alternative ARVs should be considered. In patients undergoing renal transplantation, PIs give rise to challenging DDIs with calcineurin inhibitors (http://www.hiv-druginteractions.org). Post-transplantation, acute allograft rejection and impaired renal function are common . We suggest TDF and ATV are avoided in patients who are waiting or who have undergone, renal transplantation, and that specialist advice is sought regarding PTC124 molecular weight choice and appropriate dose of ARVs. NNRTIs, DZNeP mw INIs, ABC and 3TC have not been associated with CKD and can be used in HIV-positive patients with CKD. In patients with impaired renal function, specific ARV drugs (all NRTIs except ABC) may need to be dose-adjusted . Impaired survival has been reported with ART prescription errors in patients undergoing dialysis . We recommend dose adjustment of renally cleared ARVs in patients with renal failure but caution against the risk of overinterpreting estimates of renal function for this purpose as true measures of renal function may be substantially higher in patients with mild–moderate renal impairment. Specific
ARVs that require dose adjustment in patients with reduced renal function include 3TC, FTC, TDF, DDI, ZDV and MVC (depending on PI use). For further information and advice, the reader should refer to the summary of product characteristics for each ARV. CVD is a leading cause of non-AIDS Urease morbidity and mortality among HIV-positive individuals [1, 2] and an increased risk of CVD events has been observed when compared with HIV-negative populations [3-8]. This has been attributed to the increased prevalence of surrogate markers of CVD (such as dyslipidaemia) and the proinflammatory
state associated with HIV infection. However, because ART may not mitigate (or indeed may exacerbate) these effects, caution is required in extrapolating from these makers to effects on overall mortality. The following recommendations apply to patients with, or at high risk, of CVD. For the purposes of these guidelines, patients with an elevated CVD risk are as defined in the JBS2 guidelines  and include: People with any form of established atherosclerotic CVD. Asymptomatic people who have an estimated multifactorial CVD risk >20% over 10 years. People with diabetes mellitus (type 1 or 2). People with elevated blood pressure >160 mmHg systolic or >100 mmHg diastolic, or lesser degrees of blood pressure elevation with target organ damage. People with elevated total cholesterol to high-density lipoprotein cholesterol ratio >6.0. People with familial dyslipidaemia. NICE does not recommend a specific CVD risk calculation for the UK population .