Journal
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
Volume 50, Issue 3, Pages 453-460Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.ijantimicag.2017.04.021
Keywords
HIV; Kidney; CKD; HAART; eGFR; START
Funding
- National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases [UM1 AI 068641, UM1-A1120197]
- Department of Bioethics at the NIH Clinical Center
- National Cancer Institute
- National Heart, Lung, and Blood Institute
- National Institute of Mental Health
- National Institute of Neurological Disorders and Stroke
- National Institute of Arthritis and Musculoskeletal Disorders
- French Agence Nationale de Recherches sur le SIDA et les Hepatites Virales (ANRS)
- Federal Ministry of Education and Research
- European AIDS Treatment Network (NEAT)
- National Health and Medical Research Council
- Medical Research Council
- National Institute for Health Research
- National Institute of Diabetes and Digestive and Kidney Diseases [R01 DK100272, P01 DK056492, R01 DK112258]
- National Institute on Drug Abuse [K24 DA035684, R01 DA026770]
- Medical Research Council [MC_UU_12023/23] Funding Source: researchfish
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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.
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