Document Detail

Glomerular dysfunction and associated risk factors over 4-5 years following antiretroviral therapy initiation in Africa.
MedLine Citation:
PMID:  22024517     Owner:  NLM     Status:  MEDLINE    
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.
Wolfgang Stöhr; Andrew Reid; A Sarah Walker; Francis Ssali; Paula Munderi; Ivan Mambule; Cissy Kityo; Heiner Grosskurth; Charles F Gilks; Diana M Gibb; James Hakim;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Antiviral therapy     Volume:  16     ISSN:  2040-2058     ISO Abbreviation:  Antivir. Ther. (Lond.)     Publication Date:  2011  
Date Detail:
Created Date:  2011-10-25     Completed Date:  2012-04-20     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9815705     Medline TA:  Antivir Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  1011-20     Citation Subset:  IM    
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MeSH Terms
Adenine / administration & dosage,  adverse effects,  analogs & derivatives
Antiretroviral Therapy, Highly Active / adverse effects*
CD4 Lymphocyte Count
Creatinine / blood
Dideoxynucleosides / administration & dosage,  adverse effects
Glomerular Filtration Rate
HIV Infections / complications,  drug therapy*,  physiopathology
Kidney Diseases / complications,  epidemiology*
Kidney Glomerulus / physiopathology*
Lamivudine / administration & dosage,  adverse effects
Nevirapine / administration & dosage,  adverse effects
Organophosphonates / administration & dosage,  adverse effects
Risk Factors
Time Factors
Zidovudine / administration & dosage,  adverse effects
Grant Support
G0600344//Medical Research Council; MC_U122886352//Medical Research Council; MC_U950080931//Medical Research Council; MC_U950080932//Medical Research Council; MC_U950097146//Medical Research Council; MC_U950097147//Medical Research Council; MC_UP_A910_1026//Medical Research Council; MC_UP_A910_1112//Medical Research Council; //Medical Research Council
Reg. No./Substance:
0/Dideoxynucleosides; 0/Organophosphonates; 107021-12-5/tenofovir; 2T8Q726O95/Lamivudine; 4B9XT59T7S/Zidovudine; 99DK7FVK1H/Nevirapine; AYI8EX34EU/Creatinine; JAC85A2161/Adenine; WR2TIP26VS/abacavir

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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