Document Detail

A randomized, pilot trial to evaluate glomerular filtration rate by creatinine or cystatin C in naive HIV-infected patients after tenofovir/emtricitabine in combination with atazanavir/ritonavir or efavirenz.
MedLine Citation:
PMID:  21992924     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Glomerular filtration rate (GFR) estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on creatinine or cystatine C may be more accurate methods especially in patients without chronic kidney disease. There is lack of data on GFR estimated by these methods in patients on highly active antiretroviral therapy.
METHODS: Antiretroviral-naive HIV-infected patients were randomized to tenofovir/emtricitabine in association with atazanavir/ritonavir (ATV/r) or efavirenz (EFV) Patients had to have an actual creatinine clearance >50 mL/minute (24-hour urine collection) and were followed for 48 weeks.
RESULTS: Ninety-one patients (48 ATV/r, 43 EFV) were recruited. Using the CKD-EPI creatinine formula, there was a significant decrease in GFR up to week 48 in patients receiving ATV/r (4.9 mL/minute/m(2), P = 0.02) compared with a not statistically significant increment in patients prescribed EFV. Using the cystatin C-based equation, we found greater decrease in GFR in both arms, although, in the EFV arm, the decrease was not statistically significant (5.8 mL/minute/m(2), P = 0.92). At multivariable analysis, ATV/r was a significant predictor of greater decrease in estimated glomerular filtration rate (eGFR) (P = 0.0046) only with CKD-EPI creatinine.
CONCLUSIONS: ATV/r plus tenofovir caused greater GFR decreases compared with EFV. The evaluation of eGFR by cystatin C confirmed this result, but this method seemed to be more stringent, probably precluding the possibility to detect a significant difference in the pattern of eGFR evolution between the two arms over time. More studies are needed to understand the clinical relevance of these alterations and whether cystatin C is a more appropriate method for monitoring GFR in clinical practice.
Laura Albini; Bruno Mario Cesana; Davide Motta; Emanuele Focà; Daria Gotti; Alessandra Calabresi; Ilaria Izzo; Rita Bellagamba; Rita Fezza; Pasquale Narciso; Laura Sighinolfi; Paolo Maggi; Eugenia Quiros-Roldan; Luigi Manili; Giovanni Guaraldi; Giuseppe Lapadula; Carlo Torti
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  59     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-14     Completed Date:  2012-02-02     Revised Date:  2014-02-06    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-30     Citation Subset:  IM; X    
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MeSH Terms
Adenine / administration & dosage,  adverse effects,  analogs & derivatives
Anti-HIV Agents / administration & dosage*,  adverse effects*,  therapeutic use
Benzoxazines / administration & dosage,  adverse effects
Creatinine / metabolism*
Cystatin C / metabolism*
Deoxycytidine / administration & dosage,  adverse effects,  analogs & derivatives
Glomerular Filtration Rate / drug effects*,  physiology
HIV Infections / drug therapy*
Middle Aged
Oligopeptides / administration & dosage,  adverse effects
Organophosphonates / administration & dosage,  adverse effects
Pilot Projects
Pyridines / administration & dosage,  adverse effects
Ritonavir / administration & dosage,  adverse effects
Reg. No./Substance:
0/Anti-HIV Agents; 0/Benzoxazines; 0/Cystatin C; 0/Oligopeptides; 0/Organophosphonates; 0/Pyridines; 0/emtricitabine; 0W860991D6/Deoxycytidine; 107021-12-5/tenofovir; AYI8EX34EU/Creatinine; JAC85A2161/Adenine; JE6H2O27P8/efavirenz; O3J8G9O825/Ritonavir; QZU4H47A3S/atazanavir

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

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