Evolution of renal function in African patients initiating second-line antiretroviral treatment : findings from the ANRS 12169 2LADY trial

2017

Article référencé dans le Web of Science WOS:000423269400002

Cournil Amandine, Hema A., Eymard-Duvernay Sabrina, Ciaffi L., Badiou S., Kabore F. N., Diouf A., Ayangma L., Le Moing V., Reynes J., Koulla-Shiro S., Delaporte Eric, Lady Study Grp

Antiviral Therapy, 2017, 22 (3), p. 195-203 ISSN 1359-6535

Background: To investigate change in renal function in African patients initiating second-line antiretroviral therapy (ART) including ritonavir-boosted protease inhibitor (PI/r) with or without tenofovir disoproxil fumarate (TDF). Methods: HIV-1-positive adults, failing standard first-line ART were randomized to either TDF/emtricitabine (FTC)+LPV/r, abacavir + didanosine +LPV/r or TDF/FTC+darunavir (DRV)/r and followed for 18 months. Patients with an estimated glomerular filtration rate (eGFR) >= 60 ml/min/1.73 m(2) at baseline were included in this analysis. Results: Data from 438 out of 454 randomized patients were analysed. Median age was 38 years and 72% were women. Initiation of PI/r-based second-line regimen induced a marked eGFR decline of -10.5 ml/min/1.73 m2 at week 4 in all treatment groups with a greater decrease in TDF/FTC+LPV/r arm (-15.1 ml/min/1.73 m(2)). At month 18, mean eGFR in the non-TDF containing regimen recovered its baseline level and was significantly greater than eGFR 18-month levels in the TDF-containing regimens that experienced only partial recovery (difference: -10.7; CI -16.8, -4.6; P=0.001 in TDF/FTC+LPV/r and -6.4; CI -12.5, -0.3; P=0.04 in TDF/FTC+DRV/r). At 18 months, prevalence of stage 3 chronic kidney disease was low (<3%) and not associated with treatment. One treatment discontinuation and five TDF dosage reductions for renal toxicities were reported in TDF-containing arms. Conclusions: Overall, these results suggest a reasonable renal tolerance of a regimen associating TDF/FTC+ PI/r in African patients with eGFR>60 ml/ml/1.73 m(2) at baseline. They also support the recommendation of reassessing renal function 1 month after initiation of treatment including ritonavir to account for the ritonavir-related artefactual decrease of eGFR and determine the new reference baseline value.

Santé : généralités [050] ; Entomologie médicale / Parasitologie / Virologie [052]

CAMEROUN ; BURKINA FASO ; SENEGAL ; YAOUNDE ; BOBO DIOULASSO ; DAKAR

Fonds IRD [F B010072038]

fdi:010072038