Glomerular dysfunction and associated risk factors over 4-5 years following antiretroviral therapy initiation in Africa

Stoehr, Wolfgang, Reid, Andrew, Walker, A. Sarah, Ssali, Francis, Munderi, Paula, Mambule, Ivan, Kityo, Cissy, Grosskurth, Heiner, Gilks, Charles F., Gibb, Diana M. and Hakim, James (2011) Glomerular dysfunction and associated risk factors over 4-5 years following antiretroviral therapy initiation in Africa. Antiviral Therapy, 16 7: 1011-1020. doi:10.3851/IMP1832


Author Stoehr, Wolfgang
Reid, Andrew
Walker, A. Sarah
Ssali, Francis
Munderi, Paula
Mambule, Ivan
Kityo, Cissy
Grosskurth, Heiner
Gilks, Charles F.
Gibb, Diana M.
Hakim, James
Title Glomerular dysfunction and associated risk factors over 4-5 years following antiretroviral therapy initiation in Africa
Journal name Antiviral Therapy   Check publisher's open access policy
ISSN 1359-6535
2040-2058
Publication date 2011-01-01
Year available 2011
Sub-type Article (original research)
DOI 10.3851/IMP1832
Volume 16
Issue 7
Start page 1011
End page 1020
Total pages 10
Place of publication London, United Kingdom
Publisher International Medical Press
Collection year 2011
Language eng
Formatted abstract
Background: The aim of this study was to investigate long-term renal function in HIV-infected adults initiating antiretroviral therapy (ART) with a CD4+ T-cell count <200 cells/mm3 in Africa.

Methods: This was an observational analysis within the DART trial randomizing 3,316 adults to routine laboratory and clinical monitoring (LCM) or clinically driven monitoring (CDM). Serum creatinine was measured pre-ART (all ≤360 μmol/l), at weeks 4 and 12, then every 12 weeks for 4–5 years; estimated glomerular filtration rate (eGFR) was determined using the Cockcroft–Gault formula. We analysed eGFR changes, and cumulative incidences of eGFR<30 ml/min/1.73 m2 and chronic kidney disease (CKD; <60 ml/min/1.73 m2 or 25% decrease if <60 ml/min/1.73 m2 pre-ART; confirmed >3 months).

Results: At ART initiation, median CD4+ T-cell count was 86 cells/mm3 ; 1,492 (45%) participants had mild (60–<90 ml/min/1.73 m2 ), 237 (7%) moderate (30–<60 ml/min/1.73 m2 ) and 7 (0.2%) severe (15–<30 ml/min/1.73 m2 ) decreases in eGFR. First-line ART was zidovudine/lamivudine plus tenofovir (74%), abacavir (9%) or nevirapine (17%). By 4 years, cumulative incidence of eGFR<30 ml/min/1.73 m2 was 2.8% (n=90) and CKD was 5.0% (n=162). Adjusted eGFR increases to 4 years were 1, 9 and 6 ml/min/1.73 m2 with tenofovir, abacavir and nevirapine, respectively (P<0.001), and 4 and 2 ml/min/1.73 m2 for LCM and CDM, respectively (P=0.005; 2 and 3 ml/min/1.73 m2 to 5 years; P=0.81).

Conclusions: On all regimens and monitoring strategies, severe eGFR impairment was infrequent; differences in eGFR changes were small, suggesting that first-line ART, including tenofovir, can be given safely without routine renal function monitoring. 
Keyword Chronic Kidney Disease
Hiv Infected Adults
Cockcroft Gault Equations
Renal Disease
Seropositive Patients
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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