Kidney Week

Abstract: TH-PO1129

Integrase Strand Transfer Inhibitor and Progression to CKD in an Outpatient Cohort of HIV-Infected Patients

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Author

• Franceschini, Nora, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States

Nora Franceschini,

Group or Team Name

• UNC Center for AIDS Research

Background

Recently introduced integrase strand transfer inhibitor (INSTI)-based regimens are highly effective in suppressing HIV viral load and have increased long-term survival of people living with HIV. The kidney outcomes among patients on INSTI regimens have not been compared.

Methods

The study included Center of AIDS Research (CFAR) HIV Clinical Cohort participants initiating an INSTI-based regimen (raltegravir [RAL], dolutegravir [DTG] and cobicistat-boosted elvitegravir [EVG/c]). Changes in eGFR over time were modelled using linear regression with restricted cubic splines. Multivariable Cox proportional hazards models were used to assess time to the first occurrence of low eGFR (<60 mL/min/1.73m²) in the full sample and in a sample restricted to tenofovir (TDF) users. Multivariable models were controlled for baseline age, sex, race, injection drug use as a mode of transmission, CD4 cell count, history of AIDS-defining illness, cardiovascular disease, hypertension and its pharmacological treatment, and diagnosis of diabetes and its pharmacological treatment. Patients were censored at death, lost to follow-up or October 1^st, 2016.

Results

The anchor-agents for the 920 patient-regimens consisted of RAL (n= 156, 17%), DTG (n= 360, 39%) and EVG/c (n=404, 44%). eGFR remained relatively stable over time on all three INSTI-based agent treatment, following some minimal variation over the first few months on the regimen. Compared to EVG/c, RAL was not associated with a faster progression to low eGFR (overall sample, hazard ratio [HR]: 1.08; 95% Confidence Interval [C.I.]: 0.65, 1.77 and TDF-restricted sample, HR: 0.98; 95% C.I. 0.55, 1.72). Compared to EVG/c, DTG was associated with a faster progression to low eGFR in the TDF-restricted sample (HR 1.75; 95% C.I. 1.00, 3.06), but not in the full sample (HR 1.33; 95% C.I. 0.79, 2.25).

Conclusion

The changes in eGFR over time observed for DAG regimen may be due to tubular creatinine secretion inhibition rather than kidney injury, although progression to low eGFR might be accelerated with DTG use among TDF users.

Funding

• NIDDK Support