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J Acquir Immune Defic Syndr. 2019 May 1;81(1):e6-e9. doi: 10.1097/QAI.0000000000001999.

Brief Report: Kidney Dysfunction Does Not Contribute Significantly to Antiretroviral Therapy Modification in Treatment-Naive PLWH Receiving Initial ART.

Author information

1
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
2
Rollins School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
3
Department of Medicine, Johns Hopkins University, Baltimore, MD.
4
Department of Medicine, University of California, San Diego, CA.
5
Division of Nephrology, Department of Medicine, Duke University, Durham, NC.
6
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.

Abstract

BACKGROUND:

Antiretroviral therapy (ART) durability, time to modification or cessation, has declined. The study objective was to determine whether kidney dysfunction is contributing to reduced durability.

METHODS:

This retrospective follow-up study of CNICS evaluated treatment-naive PLWH initiating ART between 2007 and 2014. Regimen modification was defined as cessation/modification of any part of the 3-drug ART regimen. We evaluated the role of kidney dysfunction in initial regimen modification as both a mediator and effect measure modifier. Associations of the variables with the ART modification were examined using univariable and multivariable Cox proportional hazard models.

RESULTS:

Of 4515 PLWH included in the analysis, 1967 modified their ART. Of those receiving TDF-based ART (n = 3888), 1580 (41%) modified their regimen compared with 387 (62%) receiving other regimens. Overall, the median eGFR decreased by 5 mL/min/1.73 m (quartiles: first = -16, third = 0) from baseline to follow-up. Of the 128 patients with low baseline eGFR (<60 mL/min/1.73 m), the final eGFR remained low in 73% while it increased to above 60 mL/min/1.73 m in 27%. Of the 4387 with normal baseline eGFR, only 135 (3%) had a final eGFR <60 mL/min/1.73 m. Those with low eGFR at the baseline and/or final visits were more likely to modify ART than others (hazards ratio = 1.75, 95% confidence interval: 1.39 to 2.19, P < 0.001). Relative to other regimens, TDF-based ART was less likely to be modified when accounting for numerous clinical and demographic traits.

CONCLUSIONS:

For patients in our study initiated on ART, including TDF-based ART, in the last decade, kidney dysfunction is not a major factor leading to regimen modification.

PMID:
30865178
PMCID:
PMC6456383
[Available on 2020-05-01]
DOI:
10.1097/QAI.0000000000001999

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