Long-term impact of immediate versus deferred antiretroviral therapy on kidney health in people with HIV.

Autor:	Pelchen-Matthews A; Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK., Mocroft A; Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Ryom L; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases 144, Hvidovre University Hospital, Copenhagen, Denmark., Ross MJ; Department of Medicine, Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York, USA., Sharma S; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA., Coca S; Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Achhra A; Department of Medicine, Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA., Cornell E; Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA., Tracy R; Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA., Phillips A; Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK., Alonso MM; Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Toulomi G; Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Agan BK; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA., Medland N; Kirby Institute, University of New South Wales, Sydney, Australia., Wyatt CM; Department of Medicine, Division of Nephrology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: christina.wyatt@duke.edu.
Jazyk:	angličtina
Zdroj:	Kidney international [Kidney Int] 2024 Jul; Vol. 106 (1), pp. 136-144. Date of Electronic Publication: 2024 May 01.
DOI:	10.1016/j.kint.2024.04.010
Abstrakt:	People with human immunodeficiency virus (HIV) are at risk for chronic kidney disease (CKD) due to HIV and antiretroviral therapy (ART) nephrotoxicity. Immediate ART initiation reduces mortality and is now the standard of care, but the long-term impact of prolonged ART exposure on CKD is unknown. To evaluate this, the Strategic Timing of Antiretroviral Treatment (START) trial randomized 4,684 ART-naïve adults with CD4 cell count under 500 cells/mm 3 to immediate versus deferred ART. We previously reported a small but statistically significantly greater decline in estimated glomerular filtration rate (eGFR) over a median of 2.1 years in participants randomized to deferred versus immediate ART. Here, we compare the incidence of CKD events and changes in eGFR and urine albumin/creatinine ratio (UACR) in participants randomized to immediate versus deferred ART during extended follow-up. Over a median of 9.3 years, eight participants experienced kidney failure or kidney-related death, three in the immediate and five in the deferred ART arms, respectively. Over a median of five years of more comprehensive follow-up, the annual rate of eGFR decline was 1.19 mL/min/1.73m 2 /year, with no significant difference between treatment arms (difference deferred - immediate arm 0.055; 95% confidence interval -0.106, 0.217 mL/min/1.73m 2 ). Results were similar in models adjusted for baseline covariates associated with CKD, including UACR and APOL1 genotype. Similarly, there was no significant difference between treatment arms in incidence of confirmed UACR 30 mg/g or more (odds ratio 1.13; 95% confidence interval 0.85, 1.51). Thus, our findings provide the most definitive evidence to date in support of the long-term safety of early ART with respect to kidney health. (Copyright © 2024 International Society of Nephrology. All rights reserved.)
Databáze:	MEDLINE
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