References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
People living with HIV have a higher risk of chronic kidney disease (CKD) than the general population. HIV itself can damage the kidneys, and some antiretroviral drugs — particularly older formulations of tenofovir — can affect kidney function over time. The good news is that with regular monitoring and modern treatment options, most kidney problems can be caught early and managed well.
Here’s what you need to know about protecting your kidneys when you’re living with HIV.
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How HIV Affects the Kidneys
HIV can harm the kidneys in several ways:
- HIV-associated nephropathy (HIVAN) — a condition where HIV directly damages kidney filtering units, more common in people of Black African or Caribbean descent
- Immune complex kidney disease — inflammation caused by the immune response to HIV
- Chronic inflammation — low-level ongoing inflammation even on effective ART
- Higher rates of diabetes, high blood pressure — both are common causes of CKD
HIV Medications and Kidney Risk
| Drug | Kidney Impact |
|---|---|
| Tenofovir disoproxil (TDF) | Can affect kidney tubular function — monitored with regular blood tests |
| Tenofovir alafenamide (TAF) | Newer version with less kidney impact |
| Atazanavir | Can cause kidney stones in a small number of people |
| Dolutegravir | Raises creatinine slightly (not actual kidney damage) |
| Most other ART | Minimal direct kidney effect |
How Kidney Health Is Monitored
Your HIV clinic checks kidney function at every routine blood test, usually every 6-12 months. Key markers include:
- eGFR (estimated glomerular filtration rate) — shows how well your kidneys are filtering
- Urine protein or albumin — protein in urine can signal kidney damage
- Creatinine — a waste product that rises when kidneys struggle
- Phosphate — can drop if tenofovir is affecting kidney tubules
Protecting Your Kidneys
- Stay on ART — uncontrolled HIV causes more kidney damage than treatment
- Control blood pressure — high blood pressure is a leading cause of CKD
- Manage blood sugar — diabetes accelerates kidney decline
- Stay hydrated
- Avoid NSAIDs (ibuprofen, naproxen) regularly — they stress the kidneys
- Stop smoking
- Attend regular clinic appointments
When to Raise Concerns
Kidney disease is often silent until advanced. Tell your HIV team if you notice:
- Unusual swelling in ankles, feet or face
- Foamy or frothy urine
- Persistent tiredness
- Reduced urine output
- Persistent nausea
Read more: Blood pressure and HIV | HIV and the immune system | What is HIV?
Frequently Asked Questions
Will HIV medication damage my kidneys?
Modern regimens using tenofovir alafenamide (TAF) have minimal kidney impact. Older tenofovir (TDF) can affect kidney function in some people, which is why it’s monitored regularly. If issues arise, your team will switch your medication.
Is kidney disease reversible?
Early-stage kidney problems are often reversible, especially if caused by medication or uncontrolled blood pressure. Advanced CKD is not reversible but can be managed to slow progression.
Am I at higher risk because of my ethnicity?
People of Black African or Caribbean descent have a higher risk of HIVAN. Regular monitoring is particularly important for this group.
Related reading
- A to Z of Sex: Sexual Health Terms Explained
- Alcohol and HIV: What You Need to Know
- Anxiety and HIV: Coping and Getting Support
- Are All STIs Curable?
- Blood Problems and HIV: Anaemia, Low Platelets and More
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
