Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.

Autor: Achhra AC; Kirby Institute, University of New South Wales, Sydney, NSW, Australia; NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA. Electronic address: aachhra@kirby.unsw.edu.au., Mocroft A; University College London, London, UK., Ross M; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Ryom-Nielson L; Department of Infectious Diseases, CHIP, Section 8632 Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Avihingsanon A; HIV-NAT, Thai Red Cross AIDS Research Centre and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand., Bakowska E; Centrum Diagnostyki i Terapii AIDS, Warsaw, Poland., Belloso W; Coordinación de Investigación Clínica Académica en Latinoamérica (CICAL) and Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Clarke A; Brighton & Sussex University Hospitals NHS Trust, Brighton, UK., Furrer H; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland., Lucas GM; School of Medicine, Johns Hopkins University, Baltimore, MD, USA., Ristola M; Division of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland., Rassool M; Cardiovascular Pathophysiology and Genomics Research Unit, University of the Witwatersrand, Johannesburg, South Africa., Ross J; University Hospital Birmingham NHS Foundation Trust, Birmingham, UK., Somboonwit C; Moroni College of Medicine, University of South Florida, Tampa, FL, USA., Sharma S; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA., Wyatt C; University College London, London, UK. Electronic address: christina.wyatt@mssm.edu.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2017 Sep; Vol. 50 (3), pp. 453-460. Date of Electronic Publication: 2017 Jun 28.
DOI: 10.1016/j.ijantimicag.2017.04.021
Abstrakt: The impact of early ART initiation (versus deferring) on kidney function has not been studied. START was a randomised comparison of immediate versus deferred ART initiation among HIV-positive persons with CD4 + (cells/mm 3 ) counts >500. Serum creatinine and urine dipstick protein were measured at Months 0, 1, 4, 8 and 12, and annually thereafter. The two arms were compared for changes in eGFR (mL/min/1.73 m 2 , calculated by CKD-EPI equation), over time using longitudinal mixed models. Of 4685 START participants, 4629 (2294 in immediate and 2335 deferred arm) were included. Median baseline CD4 + and eGFR were 651 and 111.5, respectively. ART was initiated in 2271 participants (99.0%) in the immediate and 1127 (48.3%) in the deferred arm, accounting for >94% and >19% of follow-up time, respectively. Overall, 89% started ART using a tenofovir-based regimen. Over 2.1 years median follow-up, mean eGFR was 0.56 (95% CI 0.003-1.11) higher in the immediate versus deferred arm, which was more prominent after adjustment for current tenofovir or bPI use (1.85, 95% CI 1.21-2.50) and in Black participants (30.1% overall) (3.90, 95% CI 2.84-4.97) versus non-Blacks (1.05, 95% CI 0.33-1.77) (P < 0.001 for interaction). Relative risk for proteinuria in the immediate versus deferred arm was 0.74 (95% CI 0.55-1.00) (P = 0.049). In the short-term, immediate ART initiation was associated with a modestly higher eGFR and lower proteinuria risk versus deferring ART (more pronounced in Black participants). Whether this early benefit translates into a lower risk of CKD requires further follow-up.
(Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)
Databáze: MEDLINE
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