AbstractBackgroundAdvanced kidney disease is an emerging problem in people living with HIV despite sustained viral suppression.MethodsWe performed a prospective cohort study to identify people living with HIV with advanced kidney disease according to the Kidney Disease Improving Global Outcomes criteria and to assess disease progression over a 48‐week period following the offer of targeted multidisciplinary management.ResultsFrom our cohort of 3090 individuals, 55 (1.8%, 95% confidence interval [CI] 1.31–2.25) fulfilled the inclusion criteria. Most were male (83.6%), and the median (interquartile range [IQR]) age was 58 (53.25–66.75) years. Nadir CD4 T‐cell count was 135.5 (IQR 43.5–262.75) cells/μl, current CD4 T‐cell count was 574 (IQR 438.5–816) cells/μl, and 96% had maintained HIV viral suppression. The most frequent comorbidity was arterial hypertension (85.5%).Inadequate antiretroviral dose was detected in three individuals (5.5%), and drug–drug interactions were recorded in eight (14.5%), mainly involving the use of cobicistat (n = 5 [9%]). Four individuals (7%) required modification of their concomitant treatment. Seven (13%) had to start or resume follow‐up with a nephrologist. Nine participants (16.4%) experienced an improvement in kidney disease stage, three individuals (5.5%) underwent renal transplantation, and one (2%) started haemodialysis.ConclusionsOur results show that a multidisciplinary approach, including a critical review of treatment and evaluation of specific requirements, could be useful for anticipating drug–drug interactions and toxicities and for reducing death and hospitalization in people living with HIV with advanced kidney disease.