Long-term impact of immediate versus deferred antiretroviral therapy on kidney health in people with HIV

Area of Science:

• Nephrology
• Infectious Diseases
• Clinical Trials

Background:

• People with HIV are at increased risk for chronic kidney disease (CKD).
• Antiretroviral therapy (ART) is crucial for HIV management but long-term effects on kidney health are a concern.
• Immediate ART initiation is standard care, yet its prolonged impact on CKD requires evaluation.

Purpose of the Study:

• To assess the long-term impact of immediate versus deferred ART on kidney health in HIV-positive individuals.
• To compare the incidence of CKD events and changes in kidney function markers over extended follow-up.

Main Methods:

• Analysis of data from the Strategic Timing of Antiretroviral Treatment (START) trial.
• Randomized controlled trial comparing immediate versus deferred ART in 4,684 ART-naïve adults.
• Extended follow-up to evaluate kidney failure, kidney-related death, estimated glomerular filtration rate (eGFR), and urine albumin/creatinine ratio (UACR).

Main Results:

• Over a median of 9.3 years, there were no significant differences in kidney failure or kidney-related death between immediate and deferred ART arms.
• The annual rate of eGFR decline was similar between groups over a median of five years of comprehensive follow-up.
• No significant difference was observed in the incidence of confirmed UACR 30 mg/g or more between the treatment arms.

Conclusions:

• Early initiation of ART is safe for long-term kidney health in people with HIV.
• Findings provide definitive evidence supporting the renal safety of early ART initiation.
• This supports current guidelines recommending immediate ART for all individuals with HIV.