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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