• DOI:10.3851/IMP1832
• Corpus ID: 24375312

Glomerular Dysfunction and Associated Risk Factors over 4–5 Years following Antiretroviral Therapy Initiation in Africa

@article{Sthr2011GlomerularDA,
  title={Glomerular Dysfunction and Associated Risk Factors over 4–5 Years following Antiretroviral Therapy Initiation in Africa},
  author={Wolfgang St{\"o}hr and Andrew Reid and A Sarah Walker and Francis N. Ssali and Paula Munderi and Ivan Mambule and Cissy Kityo and Heiner Grosskurth and Charles F. Gilks and Diana M. Gibb and James G Hakim},
  journal={Antiviral Therapy},
  year={2011},
  volume={16},
  pages={1011 - 1020}
}

• W. Stöhr, A. Reid, +8 authors J. Hakim
• Published 1 October 2011
• Medicine
• Antiviral Therapy

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.