Changing renal profile and early eGFR dynamics after ART initiation or switch in a large Italian HIV cohort

To assess changes in renal profile over time and short-term estimated glomerular filtration rate (eGFR) after antiretroviral treatment (ART) initiation or switch in an Italian HIV cohort.

We analyzed data from SCOLTA, a multicenter prospective pharmacovigilance cohort of people with HIV (PWH) initiating or switching ART in routine care. Participants enrolled between 2007 and 2024 with baseline eGFR ≥30 mL/min/1.73 m² and at least one renal assessment at 24 ± 4 weeks and/or 48 ± 4 weeks were included. Renal profile was assessed across calendar periods, and eGFR changes from baseline to week 24 and from week 24 to week 48 were evaluated using unadjusted analyses and multivariable general linear models including either drug cohort or calendar period.

Among 5170 participants, 25.7% were women and 18.2% were ART-naïve. Renal profile changed over time as the cohort became older and more treatment-experienced. The main decline in eGFR occurred during the first 24 weeks after ART initiation or switch, whereas changes from week 24 to week 48 were minimal. In adjusted analyses, ART-naïve participants showed a greater early decline in eGFR than ART-experienced individuals (p < 0.0001). TDF-associated changes were not consistent across the two adjusted models. Kidney-related treatment discontinuations were uncommon (26/5170, 0.5%).

In PWH with baseline eGFR ≥30 mL/min/1.73 m², kidney-related treatment discontinuations were uncommon. Renal profile changed over time, and the main decline in creatinine-based eGFR occurred during the first 24 weeks after ART initiation or switch, followed by relative stability between weeks 24 and 48.