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

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Achhra , A C , Mocroft , A , Ross , M , Ryom-Nielson , L , Avihingsanon , A , Bakowska , E , Belloso , W , Clarke , A , Furrer , H , Lucas , G M , Ristola , M , Rassool , M , Ross , J , Somboonwit , C , Sharma , S , Wyatt , C & INSIGHT START Study Grp 2017 , ' Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial ' , International Journal of Antimicrobial Agents , vol. 50 , no. 3 , pp. 453-460 . https://doi.org/10.1016/j.ijantimicag.2017.04.021

Title: Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial
Author: Achhra, Amit C.; Mocroft, Amanda; Ross, Michael; Ryom-Nielson, Lene; Avihingsanon, Anchalee; Bakowska, Elzbieta; Belloso, Waldo; Clarke, Amanda; Furrer, Hansjakob; Lucas, Gregory M.; Ristola, Matti; Rassool, Mohammed; Ross, Jonathan; Somboonwit, Charurut; Sharma, Shweta; Wyatt, Christina; INSIGHT START Study Grp
Contributor organization: Clinicum
Department of Medicine
Infektiosairauksien yksikkö
HUS Inflammation Center
Date: 2017-09
Language: eng
Number of pages: 8
Belongs to series: International Journal of Antimicrobial Agents
ISSN: 0924-8579
DOI: https://doi.org/10.1016/j.ijantimicag.2017.04.021
URI: http://hdl.handle.net/10138/298136
Abstract: 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(+) (cellsimm(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 CI94% 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 056 (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. (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Subject: HIV
Kidney
CKD
HAART
eGFR
START
CHRONIC KIDNEY-DISEASE
INFECTED PATIENTS
SERUM CREATININE
TENOFOVIR
RISK
IMMUNODEFICIENCY
NEPHROPATHY
ASSOCIATION
COBICISTAT
VARIANTS
3121 General medicine, internal medicine and other clinical medicine
317 Pharmacy
1183 Plant biology, microbiology, virology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion


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