Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa

Objectives Renal dysfunction is a significant cause of morbidity and mortality among HIV‐positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the H...

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Published in:HIV medicine 2019-07, Vol.20 (6), p.392-403
Main Authors: Bock, P, Nel, K, Fatti, G, Sloot, R, Ford, N, Voget, J, Gunst, C, Grobbelaar, N, Louis, F, Floyd, S, Hayes, R, Ayles, H, Beyers, N, Fidler, S
Format: Article
Language:English
Subjects:
Adolescent
Adult
Adults
Aged
Aged, 80 and over
Anti-Retroviral Agents - therapeutic use
Antiretroviral agents
Antiretroviral therapy
antiretroviral treatment
CD4 antigen
CD4 count
CD4 Lymphocyte Count
Confidence intervals
Disease prevention
Disease transmission
Epidermal growth factor receptors
Female
Glomerular Filtration Rate
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - pathology
HIV Infections - prevention & control
HIV/AIDS
Human immunodeficiency virus
Humans
Kidney Diseases - epidemiology
Male
Middle Aged
Morbidity
Original Research
Prevention
Regression analysis
renal dysfunction
Renal function
Retrospective Studies
South Africa
Statistical analysis
Surveys and Questionnaires
Tenofovir
Young Adult
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container_end_page 403
container_issue 6
container_start_page 392
container_title HIV medicine
container_volume 20
creator Bock, P
Nel, K
Fatti, G
Sloot, R
Ford, N
Voget, J
Gunst, C
Grobbelaar, N
Louis, F
Floyd, S
Hayes, R
Ayles, H
Beyers, N
Fidler, S
description Objectives Renal dysfunction is a significant cause of morbidity and mortality among HIV‐positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. Methods A retrospective cohort analysis of routine data for HIV‐positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR)
doi_str_mv 10.1111/hiv.12729
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This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. Methods A retrospective cohort analysis of routine data for HIV‐positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) &lt; 60 mL/min after ART initiation among individuals with a baseline (pre‐ART) eGFR ≥ 60 mL/min. Results Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/μL [interquartile range (IQR) 195–468 cells/μL], were included in the analysis. Forty‐seven individuals had a baseline eGFR &lt; 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir‐containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR &lt; 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR &lt; 60 mL/min at baseline CD4 counts of &gt; 500 cells/μL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11–0.80], 351–500 cells/μL (aOR 0.22; 95% CI 0.08–0.59) and 201–350 (aOR 0.48; 95% CI: 0.24–0.97) compared with baseline CD4 counts &lt; 200 cells/μL. Conclusions This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts &gt; 200 cells/μL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.</description><identifier>ISSN: 1464-2662</identifier><identifier>EISSN: 1468-1293</identifier><identifier>DOI: 10.1111/hiv.12729</identifier><identifier>PMID: 30963667</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Adults ; Aged ; Aged, 80 and over ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral therapy ; antiretroviral treatment ; CD4 antigen ; CD4 count ; CD4 Lymphocyte Count ; Confidence intervals ; Disease prevention ; Disease transmission ; Epidermal growth factor receptors ; Female ; Glomerular Filtration Rate ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Infections - pathology ; HIV Infections - prevention &amp; control ; HIV/AIDS ; Human immunodeficiency virus ; Humans ; Kidney Diseases - epidemiology ; Male ; Middle Aged ; Morbidity ; Original Research ; Prevention ; Regression analysis ; renal dysfunction ; Renal function ; Retrospective Studies ; South Africa ; Statistical analysis ; Surveys and Questionnaires ; Tenofovir ; Young Adult</subject><ispartof>HIV medicine, 2019-07, Vol.20 (6), p.392-403</ispartof><rights>2019 The Authors. HIV Medicine published by John Wiley &amp; Sons Ltd on behalf of British HIV Association</rights><rights>2019 The Authors. HIV Medicine published by John Wiley &amp; Sons Ltd on behalf of British HIV Association.</rights><rights>HIV Medicine © 2019 British HIV Association</rights><rights>2019 The Authors HIV Medicine published by John Wiley &amp; Sons Ltd on behalf of British HIV Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0003-3211-6078</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30963667$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bock, P</creatorcontrib><creatorcontrib>Nel, K</creatorcontrib><creatorcontrib>Fatti, G</creatorcontrib><creatorcontrib>Sloot, R</creatorcontrib><creatorcontrib>Ford, N</creatorcontrib><creatorcontrib>Voget, J</creatorcontrib><creatorcontrib>Gunst, C</creatorcontrib><creatorcontrib>Grobbelaar, N</creatorcontrib><creatorcontrib>Louis, F</creatorcontrib><creatorcontrib>Floyd, S</creatorcontrib><creatorcontrib>Hayes, R</creatorcontrib><creatorcontrib>Ayles, H</creatorcontrib><creatorcontrib>Beyers, N</creatorcontrib><creatorcontrib>Fidler, S</creatorcontrib><creatorcontrib>HPTN 071 (PopART) Team</creatorcontrib><title>Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa</title><title>HIV medicine</title><addtitle>HIV Med</addtitle><description>Objectives Renal dysfunction is a significant cause of morbidity and mortality among HIV‐positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. Methods A retrospective cohort analysis of routine data for HIV‐positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) &lt; 60 mL/min after ART initiation among individuals with a baseline (pre‐ART) eGFR ≥ 60 mL/min. Results Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/μL [interquartile range (IQR) 195–468 cells/μL], were included in the analysis. Forty‐seven individuals had a baseline eGFR &lt; 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir‐containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR &lt; 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR &lt; 60 mL/min at baseline CD4 counts of &gt; 500 cells/μL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11–0.80], 351–500 cells/μL (aOR 0.22; 95% CI 0.08–0.59) and 201–350 (aOR 0.48; 95% CI: 0.24–0.97) compared with baseline CD4 counts &lt; 200 cells/μL. Conclusions This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts &gt; 200 cells/μL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral therapy</subject><subject>antiretroviral treatment</subject><subject>CD4 antigen</subject><subject>CD4 count</subject><subject>CD4 Lymphocyte Count</subject><subject>Confidence intervals</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Epidermal growth factor receptors</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - pathology</subject><subject>HIV Infections - prevention &amp; control</subject><subject>HIV/AIDS</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Kidney Diseases - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Original Research</subject><subject>Prevention</subject><subject>Regression analysis</subject><subject>renal dysfunction</subject><subject>Renal function</subject><subject>Retrospective Studies</subject><subject>South Africa</subject><subject>Statistical analysis</subject><subject>Surveys and Questionnaires</subject><subject>Tenofovir</subject><subject>Young Adult</subject><issn>1464-2662</issn><issn>1468-1293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNpdUsFu1DAQDQhES-HAiRuyxKUctnXsrL0WEtJqKWylqqyWwAWhaOI4jdusvdjOVvl7nGxbUXzxWPPmzZvxS5I3KT5J4zlt9O4kJZyIp8lhmrHZJCWCPhvjbEIYIwfJS--vMU45FfhFckCxYJQxfvjk7VoZaFHV-7ozMmhrUNmjErxqtVFo8TlDUrUtkrYzAWmDIIaNdQHZGkHVtcEjH8AFba4QmKCdCs7utIukwSkIGxXrnLoCV7XK-6FsJL3nC41Cy_OfaOXULkIHAbnT0Hp0qcKtdTcI8xT9Wq7yyyH6iFZ227UwAs_qWslRyfxx57xRDrY9ChatVdXJfYvcgfEb7f1Qexx55uv8w-8ov6v6Qcp324UGzWunJbxKntdRhHp9dx8lP76c5Yvl5OLb1_PF_GKypUyICRNc1FOZAcE1y7KScgqS0gpXssyqmk1hhoWQKUgOZTY8VUmgJFgJDhQwPUo-7Xm3XblRlYwriAMUW6c34PrCgi4eZ4xuiiu7KxhnnM9IJDi-I3D2T6d8KOKEw5eBUbbzBSGYEZJRLiL0_X_Qa9u5-P0DKpvSbBZJI-rdv4oepNx7JgJO94Bb3ar-IZ_iYjBjEc1YjGYs4s7HgP4F6cXVWw</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Bock, P</creator><creator>Nel, K</creator><creator>Fatti, G</creator><creator>Sloot, R</creator><creator>Ford, N</creator><creator>Voget, J</creator><creator>Gunst, C</creator><creator>Grobbelaar, N</creator><creator>Louis, F</creator><creator>Floyd, S</creator><creator>Hayes, R</creator><creator>Ayles, H</creator><creator>Beyers, N</creator><creator>Fidler, S</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3211-6078</orcidid></search><sort><creationdate>201907</creationdate><title>Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa</title><author>Bock, P ; Nel, K ; Fatti, G ; Sloot, R ; Ford, N ; Voget, J ; Gunst, C ; Grobbelaar, N ; Louis, F ; Floyd, S ; Hayes, R ; Ayles, H ; Beyers, N ; Fidler, S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p3699-6979f5c4a20f644b373ac33d0dcb4df65a8099c1ac7ab465a8eb2ab20e97a3a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Adults</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Retroviral Agents - therapeutic use</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral therapy</topic><topic>antiretroviral treatment</topic><topic>CD4 antigen</topic><topic>CD4 count</topic><topic>CD4 Lymphocyte Count</topic><topic>Confidence intervals</topic><topic>Disease prevention</topic><topic>Disease transmission</topic><topic>Epidermal growth factor receptors</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - pathology</topic><topic>HIV Infections - prevention &amp; control</topic><topic>HIV/AIDS</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Kidney Diseases - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Original Research</topic><topic>Prevention</topic><topic>Regression analysis</topic><topic>renal dysfunction</topic><topic>Renal function</topic><topic>Retrospective Studies</topic><topic>South Africa</topic><topic>Statistical analysis</topic><topic>Surveys and Questionnaires</topic><topic>Tenofovir</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bock, P</creatorcontrib><creatorcontrib>Nel, K</creatorcontrib><creatorcontrib>Fatti, G</creatorcontrib><creatorcontrib>Sloot, R</creatorcontrib><creatorcontrib>Ford, N</creatorcontrib><creatorcontrib>Voget, J</creatorcontrib><creatorcontrib>Gunst, C</creatorcontrib><creatorcontrib>Grobbelaar, N</creatorcontrib><creatorcontrib>Louis, F</creatorcontrib><creatorcontrib>Floyd, S</creatorcontrib><creatorcontrib>Hayes, R</creatorcontrib><creatorcontrib>Ayles, H</creatorcontrib><creatorcontrib>Beyers, N</creatorcontrib><creatorcontrib>Fidler, S</creatorcontrib><creatorcontrib>HPTN 071 (PopART) Team</creatorcontrib><collection>Wiley_OA刊</collection><collection>Wiley Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>HIV medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bock, P</au><au>Nel, K</au><au>Fatti, G</au><au>Sloot, R</au><au>Ford, N</au><au>Voget, J</au><au>Gunst, C</au><au>Grobbelaar, N</au><au>Louis, F</au><au>Floyd, S</au><au>Hayes, R</au><au>Ayles, H</au><au>Beyers, N</au><au>Fidler, S</au><aucorp>HPTN 071 (PopART) Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa</atitle><jtitle>HIV medicine</jtitle><addtitle>HIV Med</addtitle><date>2019-07</date><risdate>2019</risdate><volume>20</volume><issue>6</issue><spage>392</spage><epage>403</epage><pages>392-403</pages><issn>1464-2662</issn><eissn>1468-1293</eissn><abstract>Objectives Renal dysfunction is a significant cause of morbidity and mortality among HIV‐positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. Methods A retrospective cohort analysis of routine data for HIV‐positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) &lt; 60 mL/min after ART initiation among individuals with a baseline (pre‐ART) eGFR ≥ 60 mL/min. Results Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/μL [interquartile range (IQR) 195–468 cells/μL], were included in the analysis. Forty‐seven individuals had a baseline eGFR &lt; 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir‐containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR &lt; 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR &lt; 60 mL/min at baseline CD4 counts of &gt; 500 cells/μL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11–0.80], 351–500 cells/μL (aOR 0.22; 95% CI 0.08–0.59) and 201–350 (aOR 0.48; 95% CI: 0.24–0.97) compared with baseline CD4 counts &lt; 200 cells/μL. Conclusions This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts &gt; 200 cells/μL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30963667</pmid><doi>10.1111/hiv.12729</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-3211-6078</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Adults
Aged
Aged, 80 and over
Anti-Retroviral Agents - therapeutic use
Antiretroviral agents
Antiretroviral therapy
antiretroviral treatment
CD4 antigen
CD4 count
CD4 Lymphocyte Count
Confidence intervals
Disease prevention
Disease transmission
Epidermal growth factor receptors
Female
Glomerular Filtration Rate
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - pathology
HIV Infections - prevention & control
HIV/AIDS
Human immunodeficiency virus
Humans
Kidney Diseases - epidemiology
Male
Middle Aged
Morbidity
Original Research
Prevention
Regression analysis
renal dysfunction
Renal function
Retrospective Studies
South Africa
Statistical analysis
Surveys and Questionnaires
Tenofovir
Young Adult
title Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa
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