%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Cournil, Amandine
%A Hema, A.
%A Eymard-Duvernay, Sabrina
%A Ciaffi, L.
%A Badiou, S.
%A Kabore, F. N.
%A Diouf, A.
%A Ayangma, L.
%A Le Moing, V.
%A Reynes, J.
%A Koulla-Shiro, S.
%A Delaporte, Eric
%A Lady Study Grp
%T Evolution of renal function in African patients initiating second-line antiretroviral treatment : findings from the ANRS 12169 2LADY trial
%D 2017
%L fdi:010072038
%G ENG
%J Antiviral Therapy
%@ 1359-6535
%K CAMEROUN ; BURKINA FASO ; SENEGAL ; YAOUNDE ; BOBO DIOULASSO ; DAKAR
%M ISI:000423269400002
%N 3
%P 195-203
%R 10.3851/imp3097
%U https://www.documentation.ird.fr/hor/fdi:010072038
%> https://www.documentation.ird.fr/intranet/publi/2018/02/010072038.pdf
%V 22
%W Horizon (IRD)
%X 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.
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