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

Publication ,  Journal Article
Achhra, AC; Mocroft, A; Ross, M; Ryom-Nielson, L; Avihingsanon, A; Bakowska, E; Belloso, W; Clarke, A; Furrer, H; Lucas, GM; Ristola, M ...
Published in: Int J Antimicrob Agents
September 2017

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/mm3) 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 m2, 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 < 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.

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Published In

Int J Antimicrob Agents

DOI

EISSN

1872-7913

Publication Date

September 2017

Volume

50

Issue

3

Start / End Page

453 / 460

Location

Netherlands

Related Subject Headings

  • Middle Aged
  • Microbiology
  • Male
  • Longitudinal Studies
  • Humans
  • HIV Infections
  • Glomerular Filtration Rate
  • Female
  • Antiretroviral Therapy, Highly Active
  • Anti-Retroviral Agents
 

Citation

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Achhra, A. C., Mocroft, A., Ross, M., Ryom-Nielson, L., Avihingsanon, A., Bakowska, E., … Wyatt, C. (2017). Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial. Int J Antimicrob Agents, 50(3), 453–460. https://doi.org/10.1016/j.ijantimicag.2017.04.021
Achhra, Amit C., Amanda Mocroft, Michael Ross, Lene Ryom-Nielson, Anchalee Avihingsanon, Elzbieta Bakowska, Waldo Belloso, et al. “Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.Int J Antimicrob Agents 50, no. 3 (September 2017): 453–60. https://doi.org/10.1016/j.ijantimicag.2017.04.021.
Achhra AC, Mocroft A, Ross M, Ryom-Nielson L, Avihingsanon A, Bakowska E, et al. Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial. Int J Antimicrob Agents. 2017 Sep;50(3):453–60.
Achhra, Amit C., et al. “Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.Int J Antimicrob Agents, vol. 50, no. 3, Sept. 2017, pp. 453–60. Pubmed, doi:10.1016/j.ijantimicag.2017.04.021.
Achhra AC, Mocroft A, Ross M, Ryom-Nielson L, Avihingsanon A, Bakowska E, Belloso W, Clarke A, Furrer H, Lucas GM, Ristola M, Rassool M, Ross J, Somboonwit C, Sharma S, Wyatt C. Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial. Int J Antimicrob Agents. 2017 Sep;50(3):453–460.

Published In

Int J Antimicrob Agents

DOI

EISSN

1872-7913

Publication Date

September 2017

Volume

50

Issue

3

Start / End Page

453 / 460

Location

Netherlands

Related Subject Headings

  • Middle Aged
  • Microbiology
  • Male
  • Longitudinal Studies
  • Humans
  • HIV Infections
  • Glomerular Filtration Rate
  • Female
  • Antiretroviral Therapy, Highly Active
  • Anti-Retroviral Agents