Evolution of renal function in African patients initiating second line antiretroviral treatment: findings from the 2LADY-ANRS 12169 trial - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Antiviral Therapy Année : 2017

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

Arsène Hema
  • Fonction : Auteur
Firmin Kabore
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Assane Diouf
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Liliane Ayangma
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Sinata Koulla-Shiro
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  • PersonId : 900411
2lady Study Group
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Résumé

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 m2 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 m2). 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 m2 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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hal-01808791 , version 1 (06-06-2018)

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Amandine Cournil, Arsène Hema, Sabrina Eymard-Duvernay, Laura Ciaffi, Stéphanie Badiou, et al.. Evolution of renal function in African patients initiating second line antiretroviral treatment: findings from the 2LADY-ANRS 12169 trial. Antiviral Therapy, 2017, 22 (3), pp.195 - 203. ⟨10.3851/IMP3097⟩. ⟨hal-01808791⟩
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