Patients with HIV who get therapy may have similar CKD results vs. patients who defer care

ByShawn M. Carter

Fact checked byGina Brockenbrough, MA

Key takeaways:

In a follow-up of 9.3 years, eight patients had kidney failure or kidney-related death.
During a median of 5 years, the annual rate of eGFR decline was 1.19 mL/min/1.73 m²/year.

Patients with HIV who undergo immediate antiretroviral therapy may not experience significant differences in chronic kidney disease outcomes compared with patients who defer treatment.

“People with HIV are at increased risk of acute kidney injury and CKD,” Annegret Pelchen-Matthews, BSc, ARCS, PhD, DIC, MSc, of the University College London, wrote with colleagues. “The current treatment paradigm for HIV includes immediate initiation of [antiretroviral therapy] in all [patients with HIV], regardless of CD4 cell count or clinical presentation.”

doctor_with_chart 2 — In a follow-up of 9.3 years, eight patients had kidney failure or kidney-related death. Image: Adobe Stock.

As part of the Strategic Timing of Antiretroviral Treatment trial, researchers randomized 4,684 patients naïve to antiretroviral therapy with a CD4 cell count of less than 500 cells/mm³ to either immediate or deferred therapy. Previous findings showed a small, but statistically significant, eGFR decline during a median of 2.1 years in patients who deferred treatment.

In an extended follow-up of 9.3 years, Pelchen-Matthews and colleagues found eight patients had kidney failure or kidney-related death, with three patients in the immediate antiretroviral therapy group and five in the deferred antiretroviral therapy group.

During a median of 5 years, the annual rate of eGFR decline was 1.19 mL/min/1.73 m²/year, with no significant difference between groups.

Results were similar in models adjusted for baseline covariates linked to CKD, such as urine albumin-creatinine ratio and apolipoprotein L1 genotype. There was also no significant difference between groups in incidence of confirmed UACR 30 mg/g or more, according to the findings.

“In the extended follow-up ... we observed no significant differences in CKD outcomes, glomerular filtration rate or albuminuria with immediate versus deferred initiation of antiretroviral therapy,” the researchers wrote. “Our results suggest that current practice has a neutral effect on kidney health and that providers should focus on traditional risk factors to reduce the incidence of CKD in people with HIV.”

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Source:

Pelchen-Matthews A, et al. Kidney Int. 2024;doi.org/10.1016/j.kint.2024.04.010.

Disclosures: The authors report receiving funding from the NIH; National Institute of Allergy and Infectious Diseases; the Department of Bioethics at the National Institutes of Health Clinical Center; the National Cancer Institute; the National Heart, Lung, and Blood Institute; the National Institute of Mental Health; the National Institute of Neurological Disorders and Stroke; and the National Institute of Arthritis and Musculoskeletal Disorders. Please see the study for all other authors’ relevant financial disclosures.

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Patients with HIV who get therapy may have similar CKD results vs. patients who defer care

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