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Does first-line antiretroviral regimen impact risk for chronic kidney disease whatever the risk group?
Philippe Flandre1, Pascal Pugliese, Clotilde Allavena
1aINSERM, UMR-S 1136 and Sorbonne Universities, UPMC University of Paris 06, Pierre Louis Institute of Epidemiology and Public Health, ParisbDepartment of Infectious Diseases, CHU Archet, NicecDepartment of Infectious Diseases, CHU Hotel Dieu, NantesdDepartment of Nephrology, Pitie Salpetriere Hospital APHP and Pierre et Marie Curie University, PariseRegional Center for HIV Care and Coordination, INSERM UMR1027, Toulouse 3 University, Toulouse, France.
Insights
The D:A:D risk score helps identify patients at high risk for chronic kidney disease (CKD) when starting antiretroviral therapy (ART). Clinicians should tailor ART regimens based on individual risk to prevent CKD, especially in high-risk individuals.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Chronic kidney disease (CKD) is a significant concern in patients with HIV, particularly those initiating antiretroviral therapy (ART).
- The D:A:D (Danish HIV cohort Study) risk score is a validated tool for predicting cardiovascular disease risk in HIV patients.
- Understanding the impact of specific ART regimens on CKD risk is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the utility of the D:A:D risk score in stratifying CKD risk among HIV patients starting ART.
- To investigate whether specific ART regimens are associated with an increased risk of developing CKD.
- To determine if the D:A:D risk score can guide the selection of ART regimens to minimize CKD incidence.
Main Methods:
- Retrospective analysis of a prospectively collected cohort of French HIV-infected patients initiating their first ART after January 1, 2004.
- Inclusion criteria: baseline estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m².
- CKD defined as confirmed eGFR < 60 ml/min/1.73 m². Incidence estimated using Kaplan-Meier, and Poisson regression used to assess relationships between CKD, ART, and D:A:D score.
Main Results:
- 6301 patients with 21,936 person-years of follow-up were analyzed; median baseline eGFR was 101 ml/min/1.73 m².
- Overall CKD incidence was 9.6/1000 person-years. Five-year CKD probabilities were 0.65%, 4.6%, and 15.9% for low, medium, and high D:A:D risk groups, respectively.
- Boosted protease inhibitor regimens showed increased CKD incidence with tenofovir use, particularly in higher D:A:D risk groups. No impact of treatment choice on CKD incidence was observed in the low-risk group.
Conclusions:
- The D:A:D risk score is valuable for stratifying CKD risk in HIV patients starting ART.
- Clinicians should consider the D:A:D score and avoid certain drugs in high-risk patients to prevent CKD.
- In low-risk patients, standard ART regimens can be safely prescribed, potentially offering economic benefits due to generic availability.
Objectives:
We used the D:A:D risk score for chronic kidney disease (CKD) for patients starting antiretroviral therapy (ART) in the recent years, and investigated whether specific regimens enhanced the risk of CKD in the different risk groups.
Design:
Retrospective analysis of a prospectively collected cohort of French HIV-infected patients.
Methods:
Patients who started their first ART after January the 1st, 2004 with a baseline estimated glomerular filtration rate (eGFR) greater than 60 ml/min per 1.73 m were analyzed. CKD was defined by confirmed eGFR less than 60 ml/min per 1.73 m. Incidence of CKD was estimated by Kaplan-Meier method, and Poisson regression models were used to quantify the relationship between CKD, exposure to the initial ART regimens and the D:A:D score.
Results:
We included 6301 patients representing 21 936 person-years of follow-up (PYFU), median eGFR at baseline was 101 ml/min per 1.73 m (inter-quartile range 86; 118) and CKD incidence 9.6/1000 PYFU. Five years probabilities of CKD were 0.65, 4.6 and 15.9% in the low, medium and high-risk groups, respectively. In patients treated with a boosted protease inhibitor, incidences rates were 7.1/1000 and 9.0/1000 PYFU in the absence or presence of tenofovir, respectively, and markedly increased with increasing risk score. In the low-risk group the treatment choice had no impact on CKD incidence.
Conclusion:
When choosing the ideal first antiretroviral regimen for one given patient, clinicians should rely on the D:A:D score and avoid some drugs in high-risk patients, whereas in low-risk patients classic regimens may be safely prescribed, with an economic benefit due to soon available generic formulations.
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