Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.
Identifieur interne : 000650 ( Main/Exploration ); précédent : 000649; suivant : 000651Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.
Auteurs : Amit C. Achhra [États-Unis] ; Amanda Mocroft [Royaume-Uni] ; Michael Ross [États-Unis] ; Lene Ryom-Nielson [Danemark] ; Anchalee Avihingsanon [Thaïlande] ; Elzbieta Bakowska [Pologne] ; Waldo Belloso [Argentine] ; Amanda Clarke [Royaume-Uni] ; Hansjakob Furrer [Suisse] ; Gregory M. Lucas [États-Unis] ; Matti Ristola [Finlande] ; Mohammed Rassool [Afrique du Sud] ; Jonathan Ross [Royaume-Uni] ; Charurut Somboonwit [États-Unis] ; Shweta Sharma [États-Unis] ; Christina Wyatt [Royaume-Uni]Source :
- International journal of antimicrobial agents [ 1872-7913 ] ; 2017.
Abstract
The impact of early ART initiation (versus deferring) on kidney function has not been studied. START was a randomised comparison of immediate versus deferred ART initiation among HIV-positive persons with CD4(+) (cells/mm(3)) counts >500. Serum creatinine and urine dipstick protein were measured at Months 0, 1, 4, 8 and 12, and annually thereafter. The two arms were compared for changes in eGFR (mL/min/1.73 m(2), calculated by CKD-EPI equation), over time using longitudinal mixed models. Of 4685 START participants, 4629 (2294 in immediate and 2335 deferred arm) were included. Median baseline CD4(+) and eGFR were 651 and 111.5, respectively. ART was initiated in 2271 participants (99.0%) in the immediate and 1127 (48.3%) in the deferred arm, accounting for >94% and >19% of follow-up time, respectively. Overall, 89% started ART using a tenofovir-based regimen. Over 2.1 years median follow-up, mean eGFR was 0.56 (95% CI 0.003-1.11) higher in the immediate versus deferred arm, which was more prominent after adjustment for current tenofovir or bPI use (1.85, 95% CI 1.21-2.50) and in Black participants (30.1% overall) (3.90, 95% CI 2.84-4.97) versus non-Blacks (1.05, 95% CI 0.33-1.77) (P < 0.001 for interaction). Relative risk for proteinuria in the immediate versus deferred arm was 0.74 (95% CI 0.55-1.00) (P = 0.049). In the short-term, immediate ART initiation was associated with a modestly higher eGFR and lower proteinuria risk versus deferring ART (more pronounced in Black participants). Whether this early benefit translates into a lower risk of CKD requires further follow-up.
DOI: 10.1016/j.ijantimicag.2017.04.021
PubMed: 28668686
Affiliations:
- Afrique du Sud, Argentine, Danemark, Finlande, Pologne, Royaume-Uni, Suisse, Thaïlande, États-Unis
- Angleterre, Canton de Berne, Floride, Gauteng, Grand Londres, Hovedstaden, Maryland, Midlands de l'Ouest, Minnesota, État de New York
- Berne, Birmingham, Copenhague, Johannesbourg, Londres, Tampa
- University College de Londres, Université de Floride du Sud, Université du Witwatersrand
Links toward previous steps (curation, corpus...)
- to stream PubMed, to step Corpus: 000E40
- to stream PubMed, to step Curation: 000E40
- to stream PubMed, to step Checkpoint: 000E40
- to stream Ncbi, to step Merge: 004339
- to stream Ncbi, to step Curation: 004339
- to stream Ncbi, to step Checkpoint: 004339
- to stream Main, to step Merge: 000650
- to stream Main, to step Curation: 000650
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.</title><author><name sortKey="Achhra, Amit C" sort="Achhra, Amit C" uniqKey="Achhra A" first="Amit C" last="Achhra">Amit C. Achhra</name><affiliation wicri:level="2"><nlm:affiliation>Kirby Institute, University of New South Wales, Sydney, NSW, Australia; NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA. Electronic address: aachhra@kirby.unsw.edu.au.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Kirby Institute, University of New South Wales, Sydney, NSW, Australia; NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Mocroft, Amanda" sort="Mocroft, Amanda" uniqKey="Mocroft A" first="Amanda" last="Mocroft">Amanda Mocroft</name><affiliation wicri:level="4"><nlm:affiliation>University College London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Ross, Michael" sort="Ross, Michael" uniqKey="Ross M" first="Michael" last="Ross">Michael Ross</name><affiliation wicri:level="2"><nlm:affiliation>Icahn School of Medicine at Mount Sinai, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Icahn School of Medicine at Mount Sinai, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Ryom Nielson, Lene" sort="Ryom Nielson, Lene" uniqKey="Ryom Nielson L" first="Lene" last="Ryom-Nielson">Lene Ryom-Nielson</name><affiliation wicri:level="3"><nlm:affiliation>Department of Infectious Diseases, CHIP, Section 8632 Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Infectious Diseases, CHIP, Section 8632 Rigshospitalet, University of Copenhagen, Copenhagen</wicri:regionArea><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Avihingsanon, Anchalee" sort="Avihingsanon, Anchalee" uniqKey="Avihingsanon A" first="Anchalee" last="Avihingsanon">Anchalee Avihingsanon</name><affiliation wicri:level="1"><nlm:affiliation>HIV-NAT, Thai Red Cross AIDS Research Centre and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.</nlm:affiliation><country xml:lang="fr">Thaïlande</country><wicri:regionArea>HIV-NAT, Thai Red Cross AIDS Research Centre and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok</wicri:regionArea><wicri:noRegion>Bangkok</wicri:noRegion></affiliation></author><author><name sortKey="Bakowska, Elzbieta" sort="Bakowska, Elzbieta" uniqKey="Bakowska E" first="Elzbieta" last="Bakowska">Elzbieta Bakowska</name><affiliation wicri:level="1"><nlm:affiliation>Centrum Diagnostyki i Terapii AIDS, Warsaw, Poland.</nlm:affiliation><country xml:lang="fr">Pologne</country><wicri:regionArea>Centrum Diagnostyki i Terapii AIDS, Warsaw</wicri:regionArea><wicri:noRegion>Warsaw</wicri:noRegion></affiliation></author><author><name sortKey="Belloso, Waldo" sort="Belloso, Waldo" uniqKey="Belloso W" first="Waldo" last="Belloso">Waldo Belloso</name><affiliation wicri:level="1"><nlm:affiliation>Coordinación de Investigación Clínica Académica en Latinoamérica (CICAL) and Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.</nlm:affiliation><country xml:lang="fr">Argentine</country><wicri:regionArea>Coordinación de Investigación Clínica Académica en Latinoamérica (CICAL) and Hospital Italiano de Buenos Aires, Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Clarke, Amanda" sort="Clarke, Amanda" uniqKey="Clarke A" first="Amanda" last="Clarke">Amanda Clarke</name><affiliation wicri:level="1"><nlm:affiliation>Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton & Sussex University Hospitals NHS Trust, Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation></author><author><name sortKey="Furrer, Hansjakob" sort="Furrer, Hansjakob" uniqKey="Furrer H" first="Hansjakob" last="Furrer">Hansjakob Furrer</name><affiliation wicri:level="3"><nlm:affiliation>Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Lucas, Gregory M" sort="Lucas, Gregory M" uniqKey="Lucas G" first="Gregory M" last="Lucas">Gregory M. Lucas</name><affiliation wicri:level="2"><nlm:affiliation>School of Medicine, Johns Hopkins University, Baltimore, MD, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Medicine, Johns Hopkins University, Baltimore, MD</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Ristola, Matti" sort="Ristola, Matti" uniqKey="Ristola M" first="Matti" last="Ristola">Matti Ristola</name><affiliation wicri:level="1"><nlm:affiliation>Division of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland.</nlm:affiliation><country xml:lang="fr">Finlande</country><wicri:regionArea>Division of Infectious Diseases, Helsinki University Hospital, Helsinki</wicri:regionArea><wicri:noRegion>Helsinki</wicri:noRegion></affiliation></author><author><name sortKey="Rassool, Mohammed" sort="Rassool, Mohammed" uniqKey="Rassool M" first="Mohammed" last="Rassool">Mohammed Rassool</name><affiliation wicri:level="4"><nlm:affiliation>Cardiovascular Pathophysiology and Genomics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Cardiovascular Pathophysiology and Genomics Research Unit, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Ross, Jonathan" sort="Ross, Jonathan" uniqKey="Ross J" first="Jonathan" last="Ross">Jonathan Ross</name><affiliation wicri:level="3"><nlm:affiliation>University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University Hospital Birmingham NHS Foundation Trust, Birmingham</wicri:regionArea><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author><author><name sortKey="Somboonwit, Charurut" sort="Somboonwit, Charurut" uniqKey="Somboonwit C" first="Charurut" last="Somboonwit">Charurut Somboonwit</name><affiliation wicri:level="4"><nlm:affiliation>Moroni College of Medicine, University of South Florida, Tampa, FL, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Moroni College of Medicine, University of South Florida, Tampa, FL</wicri:regionArea><placeName><region type="state">Floride</region><settlement type="city">Tampa</settlement></placeName><orgName type="university">Université de Floride du Sud</orgName></affiliation></author><author><name sortKey="Sharma, Shweta" sort="Sharma, Shweta" uniqKey="Sharma S" first="Shweta" last="Sharma">Shweta Sharma</name><affiliation wicri:level="2"><nlm:affiliation>Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN</wicri:regionArea><placeName><region type="state">Minnesota</region></placeName></affiliation></author><author><name sortKey="Wyatt, Christina" sort="Wyatt, Christina" uniqKey="Wyatt C" first="Christina" last="Wyatt">Christina Wyatt</name><affiliation wicri:level="4"><nlm:affiliation>University College London, London, UK. Electronic address: christina.wyatt@mssm.edu.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:28668686</idno><idno type="pmid">28668686</idno><idno type="doi">10.1016/j.ijantimicag.2017.04.021</idno><idno type="wicri:Area/PubMed/Corpus">000E40</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000E40</idno><idno type="wicri:Area/PubMed/Curation">000E40</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000E40</idno><idno type="wicri:Area/PubMed/Checkpoint">000E40</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000E40</idno><idno type="wicri:Area/Ncbi/Merge">004339</idno><idno type="wicri:Area/Ncbi/Curation">004339</idno><idno type="wicri:Area/Ncbi/Checkpoint">004339</idno><idno type="wicri:Area/Main/Merge">000650</idno><idno type="wicri:Area/Main/Curation">000650</idno><idno type="wicri:Area/Main/Exploration">000650</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.</title><author><name sortKey="Achhra, Amit C" sort="Achhra, Amit C" uniqKey="Achhra A" first="Amit C" last="Achhra">Amit C. Achhra</name><affiliation wicri:level="2"><nlm:affiliation>Kirby Institute, University of New South Wales, Sydney, NSW, Australia; NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA. Electronic address: aachhra@kirby.unsw.edu.au.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Kirby Institute, University of New South Wales, Sydney, NSW, Australia; NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Mocroft, Amanda" sort="Mocroft, Amanda" uniqKey="Mocroft A" first="Amanda" last="Mocroft">Amanda Mocroft</name><affiliation wicri:level="4"><nlm:affiliation>University College London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Ross, Michael" sort="Ross, Michael" uniqKey="Ross M" first="Michael" last="Ross">Michael Ross</name><affiliation wicri:level="2"><nlm:affiliation>Icahn School of Medicine at Mount Sinai, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Icahn School of Medicine at Mount Sinai, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Ryom Nielson, Lene" sort="Ryom Nielson, Lene" uniqKey="Ryom Nielson L" first="Lene" last="Ryom-Nielson">Lene Ryom-Nielson</name><affiliation wicri:level="3"><nlm:affiliation>Department of Infectious Diseases, CHIP, Section 8632 Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Infectious Diseases, CHIP, Section 8632 Rigshospitalet, University of Copenhagen, Copenhagen</wicri:regionArea><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Avihingsanon, Anchalee" sort="Avihingsanon, Anchalee" uniqKey="Avihingsanon A" first="Anchalee" last="Avihingsanon">Anchalee Avihingsanon</name><affiliation wicri:level="1"><nlm:affiliation>HIV-NAT, Thai Red Cross AIDS Research Centre and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.</nlm:affiliation><country xml:lang="fr">Thaïlande</country><wicri:regionArea>HIV-NAT, Thai Red Cross AIDS Research Centre and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok</wicri:regionArea><wicri:noRegion>Bangkok</wicri:noRegion></affiliation></author><author><name sortKey="Bakowska, Elzbieta" sort="Bakowska, Elzbieta" uniqKey="Bakowska E" first="Elzbieta" last="Bakowska">Elzbieta Bakowska</name><affiliation wicri:level="1"><nlm:affiliation>Centrum Diagnostyki i Terapii AIDS, Warsaw, Poland.</nlm:affiliation><country xml:lang="fr">Pologne</country><wicri:regionArea>Centrum Diagnostyki i Terapii AIDS, Warsaw</wicri:regionArea><wicri:noRegion>Warsaw</wicri:noRegion></affiliation></author><author><name sortKey="Belloso, Waldo" sort="Belloso, Waldo" uniqKey="Belloso W" first="Waldo" last="Belloso">Waldo Belloso</name><affiliation wicri:level="1"><nlm:affiliation>Coordinación de Investigación Clínica Académica en Latinoamérica (CICAL) and Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.</nlm:affiliation><country xml:lang="fr">Argentine</country><wicri:regionArea>Coordinación de Investigación Clínica Académica en Latinoamérica (CICAL) and Hospital Italiano de Buenos Aires, Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Clarke, Amanda" sort="Clarke, Amanda" uniqKey="Clarke A" first="Amanda" last="Clarke">Amanda Clarke</name><affiliation wicri:level="1"><nlm:affiliation>Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton & Sussex University Hospitals NHS Trust, Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation></author><author><name sortKey="Furrer, Hansjakob" sort="Furrer, Hansjakob" uniqKey="Furrer H" first="Hansjakob" last="Furrer">Hansjakob Furrer</name><affiliation wicri:level="3"><nlm:affiliation>Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Lucas, Gregory M" sort="Lucas, Gregory M" uniqKey="Lucas G" first="Gregory M" last="Lucas">Gregory M. Lucas</name><affiliation wicri:level="2"><nlm:affiliation>School of Medicine, Johns Hopkins University, Baltimore, MD, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Medicine, Johns Hopkins University, Baltimore, MD</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Ristola, Matti" sort="Ristola, Matti" uniqKey="Ristola M" first="Matti" last="Ristola">Matti Ristola</name><affiliation wicri:level="1"><nlm:affiliation>Division of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland.</nlm:affiliation><country xml:lang="fr">Finlande</country><wicri:regionArea>Division of Infectious Diseases, Helsinki University Hospital, Helsinki</wicri:regionArea><wicri:noRegion>Helsinki</wicri:noRegion></affiliation></author><author><name sortKey="Rassool, Mohammed" sort="Rassool, Mohammed" uniqKey="Rassool M" first="Mohammed" last="Rassool">Mohammed Rassool</name><affiliation wicri:level="4"><nlm:affiliation>Cardiovascular Pathophysiology and Genomics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Cardiovascular Pathophysiology and Genomics Research Unit, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Ross, Jonathan" sort="Ross, Jonathan" uniqKey="Ross J" first="Jonathan" last="Ross">Jonathan Ross</name><affiliation wicri:level="3"><nlm:affiliation>University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University Hospital Birmingham NHS Foundation Trust, Birmingham</wicri:regionArea><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author><author><name sortKey="Somboonwit, Charurut" sort="Somboonwit, Charurut" uniqKey="Somboonwit C" first="Charurut" last="Somboonwit">Charurut Somboonwit</name><affiliation wicri:level="4"><nlm:affiliation>Moroni College of Medicine, University of South Florida, Tampa, FL, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Moroni College of Medicine, University of South Florida, Tampa, FL</wicri:regionArea><placeName><region type="state">Floride</region><settlement type="city">Tampa</settlement></placeName><orgName type="university">Université de Floride du Sud</orgName></affiliation></author><author><name sortKey="Sharma, Shweta" sort="Sharma, Shweta" uniqKey="Sharma S" first="Shweta" last="Sharma">Shweta Sharma</name><affiliation wicri:level="2"><nlm:affiliation>Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN</wicri:regionArea><placeName><region type="state">Minnesota</region></placeName></affiliation></author><author><name sortKey="Wyatt, Christina" sort="Wyatt, Christina" uniqKey="Wyatt C" first="Christina" last="Wyatt">Christina Wyatt</name><affiliation wicri:level="4"><nlm:affiliation>University College London, London, UK. Electronic address: christina.wyatt@mssm.edu.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author></analytic><series><title level="j">International journal of antimicrobial agents</title><idno type="eISSN">1872-7913</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The impact of early ART initiation (versus deferring) on kidney function has not been studied. START was a randomised comparison of immediate versus deferred ART initiation among HIV-positive persons with CD4(+) (cells/mm(3)) counts >500. Serum creatinine and urine dipstick protein were measured at Months 0, 1, 4, 8 and 12, and annually thereafter. The two arms were compared for changes in eGFR (mL/min/1.73 m(2), calculated by CKD-EPI equation), over time using longitudinal mixed models. Of 4685 START participants, 4629 (2294 in immediate and 2335 deferred arm) were included. Median baseline CD4(+) and eGFR were 651 and 111.5, respectively. ART was initiated in 2271 participants (99.0%) in the immediate and 1127 (48.3%) in the deferred arm, accounting for >94% and >19% of follow-up time, respectively. Overall, 89% started ART using a tenofovir-based regimen. Over 2.1 years median follow-up, mean eGFR was 0.56 (95% CI 0.003-1.11) higher in the immediate versus deferred arm, which was more prominent after adjustment for current tenofovir or bPI use (1.85, 95% CI 1.21-2.50) and in Black participants (30.1% overall) (3.90, 95% CI 2.84-4.97) versus non-Blacks (1.05, 95% CI 0.33-1.77) (P < 0.001 for interaction). Relative risk for proteinuria in the immediate versus deferred arm was 0.74 (95% CI 0.55-1.00) (P = 0.049). In the short-term, immediate ART initiation was associated with a modestly higher eGFR and lower proteinuria risk versus deferring ART (more pronounced in Black participants). Whether this early benefit translates into a lower risk of CKD requires further follow-up.</div></front></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Argentine</li><li>Danemark</li><li>Finlande</li><li>Pologne</li><li>Royaume-Uni</li><li>Suisse</li><li>Thaïlande</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Canton de Berne</li><li>Floride</li><li>Gauteng</li><li>Grand Londres</li><li>Hovedstaden</li><li>Maryland</li><li>Midlands de l'Ouest</li><li>Minnesota</li><li>État de New York</li></region><settlement><li>Berne</li><li>Birmingham</li><li>Copenhague</li><li>Johannesbourg</li><li>Londres</li><li>Tampa</li></settlement><orgName><li>University College de Londres</li><li>Université de Floride du Sud</li><li>Université du Witwatersrand</li></orgName></list><tree><country name="États-Unis"><region name="État de New York"><name sortKey="Achhra, Amit C" sort="Achhra, Amit C" uniqKey="Achhra A" first="Amit C" last="Achhra">Amit C. Achhra</name></region><name sortKey="Lucas, Gregory M" sort="Lucas, Gregory M" uniqKey="Lucas G" first="Gregory M" last="Lucas">Gregory M. Lucas</name><name sortKey="Ross, Michael" sort="Ross, Michael" uniqKey="Ross M" first="Michael" last="Ross">Michael Ross</name><name sortKey="Sharma, Shweta" sort="Sharma, Shweta" uniqKey="Sharma S" first="Shweta" last="Sharma">Shweta Sharma</name><name sortKey="Somboonwit, Charurut" sort="Somboonwit, Charurut" uniqKey="Somboonwit C" first="Charurut" last="Somboonwit">Charurut Somboonwit</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Mocroft, Amanda" sort="Mocroft, Amanda" uniqKey="Mocroft A" first="Amanda" last="Mocroft">Amanda Mocroft</name></region><name sortKey="Clarke, Amanda" sort="Clarke, Amanda" uniqKey="Clarke A" first="Amanda" last="Clarke">Amanda Clarke</name><name sortKey="Ross, Jonathan" sort="Ross, Jonathan" uniqKey="Ross J" first="Jonathan" last="Ross">Jonathan Ross</name><name sortKey="Wyatt, Christina" sort="Wyatt, Christina" uniqKey="Wyatt C" first="Christina" last="Wyatt">Christina Wyatt</name></country><country name="Danemark"><region name="Hovedstaden"><name sortKey="Ryom Nielson, Lene" sort="Ryom Nielson, Lene" uniqKey="Ryom Nielson L" first="Lene" last="Ryom-Nielson">Lene Ryom-Nielson</name></region></country><country name="Thaïlande"><noRegion><name sortKey="Avihingsanon, Anchalee" sort="Avihingsanon, Anchalee" uniqKey="Avihingsanon A" first="Anchalee" last="Avihingsanon">Anchalee Avihingsanon</name></noRegion></country><country name="Pologne"><noRegion><name sortKey="Bakowska, Elzbieta" sort="Bakowska, Elzbieta" uniqKey="Bakowska E" first="Elzbieta" last="Bakowska">Elzbieta Bakowska</name></noRegion></country><country name="Argentine"><noRegion><name sortKey="Belloso, Waldo" sort="Belloso, Waldo" uniqKey="Belloso W" first="Waldo" last="Belloso">Waldo Belloso</name></noRegion></country><country name="Suisse"><region name="Canton de Berne"><name sortKey="Furrer, Hansjakob" sort="Furrer, Hansjakob" uniqKey="Furrer H" first="Hansjakob" last="Furrer">Hansjakob Furrer</name></region></country><country name="Finlande"><noRegion><name sortKey="Ristola, Matti" sort="Ristola, Matti" uniqKey="Ristola M" first="Matti" last="Ristola">Matti Ristola</name></noRegion></country><country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Rassool, Mohammed" sort="Rassool, Mohammed" uniqKey="Rassool M" first="Mohammed" last="Rassool">Mohammed Rassool</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Main/Exploration
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000650 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 000650 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Main
|étape= Exploration
|type= RBID
|clé= pubmed:28668686
|texte= Impact of early versus deferred antiretroviral therapy on estimated glomerular filtration rate in HIV-positive individuals in the START trial.
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Exploration/RBID.i -Sk "pubmed:28668686" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
| This area was generated with Dilib version V0.6.32. |  |