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


ABSTRACT: 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?

SUBMITTER: Achhra AC 

PROVIDER: S-EPMC5581703 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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

Achhra Amit C AC   Mocroft Amanda A   Ross Michael M   Ryom-Nielson Lene L   Avihingsanon Anchalee A   Bakowska Elzbieta E   Belloso Waldo W   Clarke Amanda A   Furrer Hansjakob H   Lucas Gregory M GM   Ristola Matti M   Rassool Mohammed M   Ross Jonathan J   Somboonwit Charurut C   Sharma Shweta S   Wyatt Christina C  

International journal of antimicrobial agents 20170628 3


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<sup>+</sup> (cells/mm<sup>3</sup>) 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 m<sup>2</sup>, calculated by CKD-EPI equation), over time using longitu  ...[more]

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