Back to Search
Start Over
Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial
- Source :
- International journal of antimicrobial agents. 50(3)
- Publication Year :
- 2016
-
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 + (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 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.
- Subjects :
- CHRONIC KIDNEY-DISEASE
0301 basic medicine
Male
HAART
HIV Infections
Urine
VARIANTS
Kidney
chemistry.chemical_compound
0302 clinical medicine
Antiretroviral Therapy, Highly Active
eGFR
Medicine
Pharmacology (medical)
030212 general & internal medicine
Longitudinal Studies
1183 Plant biology, microbiology, virology
RISK
INFECTED PATIENTS
IMMUNODEFICIENCY
Proteinuria
Cobicistat
ASSOCIATION
General Medicine
Middle Aged
Infectious Diseases
Anti-Retroviral Agents
317 Pharmacy
Female
medicine.symptom
Glomerular Filtration Rate
Microbiology (medical)
Adult
medicine.medical_specialty
NEPHROPATHY
Renal function
Lower risk
Article
Nephropathy
03 medical and health sciences
Internal medicine
CKD
Humans
AIDS-Associated Nephropathy
Aged
Creatinine
SERUM CREATININE
business.industry
HIV
medicine.disease
030112 virology
Surgery
COBICISTAT
Regimen
chemistry
3121 General medicine, internal medicine and other clinical medicine
TENOFOVIR
business
START
Subjects
Details
- ISSN :
- 18727913
- Volume :
- 50
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- International journal of antimicrobial agents
- Accession number :
- edsair.doi.dedup.....2837d20777ae8907640e39da7af4bfb9