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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.

Author(s): Albini L, Cesana BM, Motta D, Foca E, Gotti D, Calabresi A, Izzo I, Bellagamba R, Fezza R, Narciso P, Sighinolfi L, Maggi P, Quiros-Roldan E, Manili L, Guaraldi G, Lapadula G, Torti C

Affiliation(s): 1Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy 2Institute of Statistics in Medicine, University of Brescia, Brescia, Italy 3National Institute of Infectious Diseases, Rome, Italy 4Infectious Disease Department, S. Anna Hospital, Ferrara, Italy 5Infectious Diseases Institute, Policlinico di Bari, Bari, Italy 6Nephrology Department, Spedali Civili di Brescia, Brescia, Italy 7Institute of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Modena, Italy 8Infectious Disease Department, "S. Gerardo" General Hospital, Monza, Italy.

Publication date & source: 2011-10-11, J Acquir Immune Defic Syndr., [Epub ahead of print]

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 HAART. METHODS: Antiretroviral-naive HIV-infected patients were randomized to TDF/emtricitabine (FTC) in association with ATV/r or EFV. Patients had to have an actual creatinine clearance >50 ml/min (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/min/m; P =0.02) compared to 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/min/m, P=0.92). At multivariable analysis, ATV/r was a significant predictor of greater decrease in eGFR (P=0.0046) only with CKD-EPI creatinine. CONCLUSIONS: ATV/r plus TDF caused greater GFR decreases compared to EFV. The evaluation of eGFR by cystatin C confirmed this result but this method appeared 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.

Page last updated: 2011-12-09

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