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Brief Report

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

Eaton, Ellen F., MD, MSPHa; Tamhane, Ashutosh, MD, PhDa; Davy-Mendez, Thibaut, MSPHb; Moore, Richard D., MDc; Mathews, W. Christopher, MD, MSPHd; Saag, Michael S., MDa; Mugavero, Michael J., MD, MHSca; Wyatt, Christina M., MDe; Gutierrez, Orlando M., MD, MMScf

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1, 2019 - Volume 81 - Issue 1 - p e6–e9
doi: 10.1097/QAI.0000000000001999
Clinical Science

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 m2 (quartiles: first = −16, third = 0) from baseline to follow-up. Of the 128 patients with low baseline eGFR (<60 mL/min/1.73 m2), the final eGFR remained low in 73% while it increased to above 60 mL/min/1.73 m2 in 27%. Of the 4387 with normal baseline eGFR, only 135 (3%) had a final eGFR <60 mL/min/1.73 m2. 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.

aDivision of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;

bRollins School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, NC;

cDepartment of Medicine, Johns Hopkins University, Baltimore, MD;

dDepartment of Medicine, University of California, San Diego, CA;

eDivision of Nephrology, Department of Medicine, Duke University, Durham, NC; and

fDivision of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.

Correspondence to: Ellen F. Eaton, MD, MSPH, Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 845 19th Street South, BBRB 206 A, Birmingham, AL 35294 (e-mail:

E.F.E. has received research support from the AHRQ (K12HS023009), the Gilead HIV Research Scholarship, and Viiv. A.T., W.C.M., T.D.-M., C.M.W., R.M. have received research support from NIH (U01 DA036935, P30 AI094189, U01AI069918). M.J.M. reports personal fees from the Gilead Foundation and a grant from Bristol-Myers Squibb outside the submitted work. M.S.S. reports grants from Merck, Bristol-Myers Squibb, Gilead, ViiV Healthcare, AbbVie, and Proteus and personal fees from Merck, Bristol-Myers Squibb, and Gilead outside the submitted work.

The remaining authors report no conflicts of interest to disclose.

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Received August 29, 2018

Accepted January 14, 2019

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