More frequent monitoring of renal function (every 4 weeks during the first year, and every 3 months thereafter)

is recommended in the SPC for tenofovir. Referral to a renal physician should be considered for patients suspected to have a glomerulonephritis (haematuria and/or uPCR >100 mg/mmol) and those with a severe or progressive decline in renal function, advanced renal failure (eGFR <30 mL/min) or severe hypertension associated with renal injury (uPCR >100 mg/mmol or eGFR <60 mL/min) (IV). HIV infection is associated with increased levels of triglycerides and decreased levels of high-density lipoprotein (HDL) cholesterol. ART may affect lipid levels and independently increase cardiovascular risk [22-26]. CVD is an increasingly important cause of mortality and morbidity in patients with HIV infection in the UK [27], emphasizing the importance PD-0332991 in vitro of assessing lipid profiles and managing dyslipidaemia find more (as part of the overall cardiovascular risk) in those with HIV infection. Lipid levels should be assessed in the context of overall CVD risk. CVD risk assessments generally incorporate

age, gender, smoking, blood pressure, diabetes, the ratio of total:HDL cholesterol, and the presence or absence of left ventricular hypertrophy on electrocardiogram [28]. The Framingham CVD risk calculator works reasonably well in HIV-positive populations, although it is worth noting that it was not developed for use in non-White groups. Other algorithms may be better suited to these populations. A CVD risk calculator has been developed for use in HIV-positive populations (www.chip.dk/TOOLS) [29], although it should be noted that this provides 5-year risk estimates rather than the usual 10-year estimates. learn more This calculator includes abacavir exposure as a CVD risk factor; the data regarding abacavir as a CVD risk factor, however, remain inconsistent. Alternatively,

the QRISK calculator (www.qrisk.org) or the QIntervention tool (http://qintervention.org), which also provide an estimate of the risk of developing type II diabetes, can be used. CVD risk can be reduced by smoking cessation, blood-pressure management (including nonpharmacological measures) and lipid-lowering interventions. Smoking cessation should be repeatedly encouraged. Weight reduction, diet and exercise may improve blood pressure and HDL-cholesterol levels. Decisions on lipid-lowering therapy should be based on overall cardiovascular risk rather than lipid levels in isolation. D-dimer levels, highly sensitive CRP, and IL-6 have recently been correlated with cardiovascular events and death [30]. While these biomarkers may become useful in identifying high-risk patients and contribute to the debate regarding when to start ART, they remain research tools and are not recommended for routine evaluation at present (IV).