Safe Kidney Health with Early Antiretroviral Therapy

TL/DR –

A study published in Kidney International has shown that early treatment with antiretroviral therapy (ART) is safe for patients with HIV. The study compared potential nephrotoxic effects of ART with the decline in estimated glomerular filtration rate (eGFR) in HIV patients over a 5.5-year period, finding that the benefits of the medication outweighed the risks. The researchers concluded that ART provides crucial virologic suppression and immune reconstitution, confirming that the early initiation of the treatment is safe in terms of kidney health.

Early Antiretroviral Therapy Safe for HIV Patients: Study

Early treatment with antiretroviral therapy (ART) is safe for patients with HIV, a study published in Kidney International claims. This study dismisses concerns that prolonged exposure to potentially nephrotoxic ART could be more harmful than beneficial.

HIV, ART, and Kidney Concerns

HIV patients have a heightened risk of kidney-related issues, such as acute kidney injury and chronic kidney disease (CKD), due to the effects of HIV, traditional risk factors, and potential nephrotoxicity from ART. A two-year follow-up of the START trial noted a decline in estimated glomerular filtration rate (eGFR) in patients who either deferred or immediately started ART. The study followed up on START trial participants after 5.5 years and documented CKD events for 9.3 years.

About the START Trial Participants

The START trial consisted of ART-naïve participants diagnosed with HIV and a CD4 cell count of less than 500 cells/mm³. Participants were randomly allocated to either immediate ART or deferred ART until disease progression. Participants on dialysis were excluded, and there were no other limitations based on kidney function.

START Trial Findings

With 4684 participants split into two groups between 2009 and 2013, only three experienced a CKD event by 2015, two of them from the deferred ART group. This number increased to nine CKD events in eight participants by the end of 2021.

The analysis included 4284 participants, 30.4% of whom were Black. Their median age was 36 years at the start of the study, and the median baseline eGFR was 111 mL/min/1.73m². The rate of eGFR decline was similar in both groups.

Limitations and Conclusion

The study had a few limitations, such as the inclusion of participants using medications that affected creatinine secretion in both groups and unstandardized serum creatinine measurement. The advanced CKD incidence was difficult to compare with previous START trials in HIV patients. However, the study concluded that early ART initiation is safe for HIV patients concerning kidney health. The benefits of ART, including virologic suppression and immune reconstitution, outweigh potential nephrotoxicity.

References

1. Pelchen-Matthews A, Mocroft A, Ryom L, et al. Long-term impact of immediate versus deferred antiretroviral therapy on kidney health in people with HIV. Kidney Int. Published online April 30, 2024. doi:10.1016/j.kint.2024.04.010
2. Achhra AC, Mocroft A, Ross M, et al. Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial. Int J Antimicrob Agents. Sep 2017;50(3):453-460. doi:10.1016/j.ijantimicag.2017.04.021

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