Cournil Amandine auteur aut IRD Hema A. auteur aut IRD Eymard-Duvernay Sabrina auteur aut IRD Ciaffi L. auteur aut IRD Badiou S. auteur aut IRD Kabore F. N. auteur aut IRD Diouf A. auteur aut IRD Ayangma L. auteur aut IRD Le Moing V. auteur aut IRD Reynes J. auteur aut IRD Koulla-Shiro S. auteur aut IRD Delaporte Eric auteur aut IRD Lady Study Grp auteur aut IRD text journalArticle eng text/pdf born digital access 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. specialized CAMEROUN BURKINA FASO SENEGAL YAOUNDE BOBO DIOULASSO DAKAR 050 052 22 3 195-203 2017 1359-6535 https://www.documentation.ird.fr/hor/fdi:010072038 10.3851/imp3097 1359-6535 [F B010072038] https://www.documentation.ird.fr/hor/fdi:010072038 https://www.documentation.ird.fr/intranet/publi/2018/02/010072038.pdf Accès réservé (Intranet de l'IRD) IRD - Base Horizon / Pleins textes 2018-03-05 2023-07-11 fdi:010072038 fre