If you take HIV medicine, your clinic checks your kidneys with blood and urine tests, sometimes several times a year. That can make people nervous: is the medicine damaging my kidneys? For most people the answer is no. But a few HIV medicines do need watching. One of them, tenofovir, is in many of the most common pills. And one common blood test can rise for a reason that has nothing to do with damage.
This guide explains what the tests measure, which medicines matter, and when a change is worth worrying about.
HIV itself is a risk to the kidneys
It helps to start with the bigger picture. The main causes of kidney disease in anyone are diabetes and high blood pressure. Heart disease, a family history of kidney disease and getting older add to the risk. In people with HIV, poorly controlled HIV and hepatitis C infection raise it further1.
That is why the first piece of kidney advice from the US National Institutes of Health is simply to take HIV medicine as prescribed and keep the virus under control1. Stopping treatment out of worry about your kidneys usually does more harm than good.
How your kidneys are checked
Kidney checks are a normal part of HIV care. Before starting medicines such as Biktarvy, and from time to time afterwards, the US label asks for these tests2:
- Creatinine. A waste product made by your muscles. Healthy kidneys filter it out, so a high blood level can be a sign the kidneys are not working well. But creatinine also depends on how much muscle you have, what you eat, your age and how active you are, so it is never read on its own3.
- eGFR (estimated glomerular filtration rate). A number worked out from your creatinine, age and other details. It estimates how fast your kidneys filter your blood and is a better guide than creatinine alone3. Some prescribing rules use a similar figure called creatinine clearance.
- Urine tests for protein and sugar (glucose). Protein in the urine can be an early sign of kidney damage4.
- Phosphate in the blood, for people who already have chronic kidney disease2.
As a rough guide, an eGFR of 90 or more usually means no kidney disease, 60 to 90 can mean early kidney disease, 15 to 60 suggests kidney disease, and below 15 suggests kidney failure. The test is not perfect, and a single odd result can happen without any kidney damage, so your clinic looks at the trend over time4.
The creatinine rise that is not kidney damage
Here is the part that surprises many people. Dolutegravir (in Tivicay, Dovato and Triumeq) and bictegravir (in Biktarvy) both raise blood creatinine a little in the first few weeks.
The reason is how creatinine leaves the body. Part of it is pushed into the urine by small “pumps” in the kidney tubes. These medicines partly block those pumps, so a little more creatinine stays in the blood. The kidneys’ actual filtering is not affected. Both US labels say this in almost the same words: the rise comes from blocking creatinine secretion “without affecting renal glomerular function”25.
What it looks like in practice:
- It appears within about the first 4 weeks, then stays level.
- It is small. In the main trials, creatinine rose by about 0.11 mg/dL on Biktarvy over almost three years, and by about 0.15 mg/dL on dolutegravir over two years (roughly 10 to 13 micromol/L, the units used in the UK and Australia)25.
- Because eGFR is calculated from creatinine, your eGFR may dip a little at the same time.
Your clinic expects this, which is why they compare later results with your new baseline after the first month rather than with the result before you started. A rise that keeps going, or protein appearing in the urine, is a different matter and will be looked into. Some clinics may also use other tests, such as cystatin C, when creatinine is hard to read4.
Tenofovir: the medicine most often watched
Tenofovir is one of the most widely used HIV medicines. It comes in two forms:
- Tenofovir disoproxil fumarate (TDF), the older form, found in Viread, Truvada, Atripla and many generic combinations.
- Tenofovir alafenamide (TAF), the newer form, found in Biktarvy, Descovy, Genvoya, Odefsey and Vemlidy.
Our guide to Truvada vs Descovy explains the difference between the two forms in detail. Here we focus on the kidneys.
TDF and the kidneys
Tenofovir is cleared from the body mainly by the kidneys. Kidney problems with TDF are uncommon, but they can be serious: the label lists kidney failure and a condition called Fanconi syndrome, where the kidney tubes leak important minerals such as phosphate into the urine6. US guidelines note that people whose kidney function is already a little reduced are more at risk7.
Two practical points from the Viread label are worth knowing6:
- Painkillers. TDF should be avoided with high-dose or several anti-inflammatory painkillers (NSAIDs, such as ibuprofen, naproxen or diclofenac). Sudden kidney failure has been reported in people with kidney risk factors who started these painkillers while on TDF. If you need regular pain relief, ask about alternatives. Our guide to NSAIDs explains this group of medicines.
- Bone and muscle pain. Ongoing bone pain, pain in the arms or legs, fractures, or muscle weakness can be a sign of tubule damage, and should prompt a kidney check.
TAF and the kidneys
TAF was developed so that less tenofovir circulates in the blood. In the large DISCOVER study, which compared Descovy (TAF) with Truvada (TDF) for PrEP, kidney test results were slightly better on average with Descovy over 48 weeks8. The label is careful to add that the long-term meaning of these differences is not known.
TAF is not completely free of kidney effects. Kidney problems, including Fanconi syndrome, have been reported with TAF medicines too, mostly in people with other risk factors, so the same tests are still done28.
Other tenofovir side effects
Kidneys are the best-known issue, but they are not the only one:
- Stomach upset. Diarrhoea, nausea, headache and tiredness were the most common side effects of both Truvada and Descovy in DISCOVER, each reported by a small minority of people8. These usually settle in the first weeks.
- Bone density. TDF causes a slightly bigger drop in bone density than other HIV medicines in trials. What this means for fracture risk over many years is not known6. In DISCOVER, bone density rose slightly on Descovy and fell slightly on Truvada8. Our guide to long-term side effects of HIV treatment covers bones in more detail.
- Hepatitis B flare on stopping. Tenofovir also treats hepatitis B. If you have hepatitis B, stopping tenofovir suddenly can cause a serious flare of liver inflammation6. See our hepatitis B treatment guide.
Atazanavir and kidney stones
Atazanavir (Reyataz, and part of Evotaz) is an older protease inhibitor. Kidney stones and gallstones have been reported in people taking it, and some needed hospital treatment. Long-term kidney disease has also been reported, including cases where crystals of the drug were found in kidney tissue9.
The patient information advises drinking plenty of fluids while taking atazanavir, and getting in touch straight away with symptoms of a kidney stone: pain in the lower back or lower stomach area, blood in the urine, or pain when passing urine9. US guidelines say problems like this can usually be handled by swapping the medicine responsible for another one, without stopping HIV treatment7.
Who needs closer kidney checks
Your clinic may check more often if you have146:
- diabetes or high blood pressure
- heart disease, or a family history of kidney disease
- older age
- hepatitis C, or HIV that is not yet under control
- regular use of anti-inflammatory painkillers
- a kidney result that is already a little below normal
If blood pressure is part of the picture, good control protects the kidneys. Our article on ACE inhibitors and ARBs explains two common blood pressure medicines that are often chosen when the kidneys need protecting.
If your kidney function drops
A lower kidney result does not automatically mean stopping HIV treatment. Depending on the medicine, your team may change the dose, change how often you take it, or switch to a different regimen. The labels set clear limits:
| Medicine | What the US label says about reduced kidney function |
|---|---|
| Viread (TDF 300 mg) | Taken less often when creatinine clearance is below 50 mL/min: every 48 hours at 30 to 49, every 72 to 96 hours at 10 to 29, and weekly after dialysis6 |
| Biktarvy | Not recommended at 15 to below 30 mL/min, or below 15 unless on regular haemodialysis (and already treated for HIV before)2 |
| Dovato | Not recommended below 30 mL/min, because the fixed tablet cannot be adjusted10 |
| Triumeq | Not recommended below 30 mL/min11 |
These are decisions for your HIV team, often together with a kidney specialist. Never change the dose or the timing yourself.
Looking after your kidneys on HIV treatment
- Take your HIV medicine every day. Controlled HIV is kinder to the kidneys than uncontrolled HIV1.
- Keep blood pressure and blood sugar in range, and go to your check-ups, including the blood and urine tests.
- Ask before using painkillers regularly, especially if you take TDF.
- Tell every prescriber and pharmacist that you take HIV medicine, including for over-the-counter products and supplements. Our guide to HIV medicine interactions covers the common ones.
- Eat well and stay active. The NIH suggests fresh fruit and vegetables, whole grains, less salt and sugar, and at least 30 minutes of activity on most days1.
Symptoms to report
Early kidney problems usually cause no symptoms at all, which is why the tests matter. Later signs can include swelling of the legs, ankles or feet, passing more or less urine than usual, tiredness or trouble sleeping, nausea, itching or numbness1. On TDF, also mention ongoing bone pain or muscle weakness, and on atazanavir, the kidney stone symptoms above.
We supply both forms of tenofovir: TDF, such as Tenvir 300 mg, and TAF, such as Tenvir-AF, as well as combination pills such as Taffic (with TAF) and Xapavir LT (with TDF). Your team will choose the right one for your kidneys, and all need a prescription.
Frequently asked questions
Can HIV medication cause kidney failure?
It is rare. Kidney failure has been reported with tenofovir, mostly in people who already had kidney risk factors or were taking other medicines that strain the kidneys. Uncontrolled HIV, diabetes and high blood pressure are bigger causes of kidney disease, which is why regular tests and steady treatment matter.
Why did my creatinine go up on Biktarvy or Dovato?
Bictegravir and dolutegravir block the way creatinine is pushed into the urine, so blood creatinine rises a little in the first month and then stays level. The US labels state that this does not affect how well the kidneys filter. Your clinic will watch for a rise that keeps going.
Does Dovato affect the kidneys?
Dovato contains no tenofovir. Its dolutegravir causes the small, harmless creatinine rise described above. Dovato is not recommended when kidney function (creatinine clearance) is below 30 mL/min, because the fixed-dose tablet cannot be adjusted.
Is TAF safer for the kidneys than TDF?
In the DISCOVER study, kidney test results were slightly better on average with TAF (Descovy) than with TDF (Truvada), though the long-term meaning of the difference is not known. Kidney problems have been reported with both, so the same checks apply.
Can I take ibuprofen with tenofovir?
An occasional dose is a question for your pharmacist. The Viread label advises avoiding high-dose or several anti-inflammatory painkillers together with TDF, because sudden kidney failure has been reported in people with kidney risk factors. Ask about alternatives if you need pain relief often.
What are the most common side effects of tenofovir?
Mild stomach upset, nausea, diarrhoea, headache and tiredness, usually in the first weeks. Less common but more important are effects on the kidneys and on bone density, and a hepatitis B flare if someone with hepatitis B stops it suddenly.
Do I have to stop my HIV medicine if my eGFR drops?
Not usually. Your team will first check whether the drop is real and what is causing it. They may adjust the dose, change how often you take it, or switch one medicine for another, while keeping you on effective treatment.
Sources & references
- National Institutes of Health (HIVinfo). HIV and Kidney Disease. Last reviewed 31 March 2025.
- US National Library of Medicine, DailyMed. Biktarvy prescribing information.
- MedlinePlus (US National Library of Medicine). Creatinine Test.
- MedlinePlus (US National Library of Medicine). Glomerular Filtration Rate (GFR) Test. Updated 30 September 2026.
- US National Library of Medicine, DailyMed. Tivicay (dolutegravir) prescribing information.
- US National Library of Medicine, DailyMed. Viread (tenofovir disoproxil fumarate) prescribing information.
- US Department of Health and Human Services, Clinicalinfo. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents: Adverse Effects of Antiretroviral Medications. Updated 25 September 2025.
- US National Library of Medicine, DailyMed. Descovy prescribing information (including DISCOVER trial results).
- US National Library of Medicine, DailyMed. Reyataz (atazanavir) prescribing information and patient information.
- US National Library of Medicine, DailyMed. Dovato prescribing information.
- US National Library of Medicine, DailyMed. Triumeq prescribing information.
Related reading
- Truvada vs Descovy: which tenofovir
- Dovato vs Biktarvy vs Triumeq
- Tenofovir disoproxil fumarate medicines and tenofovir alafenamide medicines
- Generic Viread and generic Vemlidy
- Kidney care medicines and all HIV and PrEP medicines
This content is for informational purposes only and is not medical advice. Kidney results need to be read alongside your full health history, so always discuss them with your HIV team. Never stop or change HIV medicine on your own. Used as prescribed by a licensed medical professional.
Nancy Kapadia is a licensed clinical pharmacist with 10 years of experience. She holds a B.Pharm from Baba Farid University. At OnlineMeds, she reviews medicine and health content to help ensure it is accurate, evidence-based, and easy to understand.