Impaired creatinine-based estimated glomerular filtration rate in Thai individuals switching to dolutegravir: illustrating the role of cystatin C testing to aid clinical decision making

Impaired creatinine-based estimated glomerular filtration rate in Thai individuals switching to dolutegravir: illustrating the role of cystatin C testing to aid clinical decision making

Abstract Introduction Data about impact of switch to dolutegravir (DTG)-based antiretroviral therapy (ART) on estimated glomerular filtration rate (eGFR) in Asians are scarce. RV254/SEARCH010 is a prospective observational cohort in Bangkok, Thailand with ART initiation during acute HIV infection (A...

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Main Authors: Carlo Sacdalan, Curtis Austin, Aswathy Varma, Suteeraporn Pinyakorn, Eugène Kroon, Donn J. Colby, Phillip Chan, Orlanda Goh, Krittaporn Pornpaisakul, Jintana Intasan, Tassanee Luekasemsuk, Merlin L. Robb, Nitiya Chomchey, Nittaya Phanuphak, Jintanat Ananworanich, Sandhya Vasan, Denise Hsu, the SEARCH 010/RV254 study group
Format: Article
Language:English
Published: BMC 2025-02-01
Series:AIDS Research and Therapy
Subjects:
Glomerular filtration rate
HIV infection
Renal insufficiency
Creatinine
Cystatin C
Dolutegravir
Online Access:https://doi.org/10.1186/s12981-025-00712-0
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Summary:Abstract Introduction Data about impact of switch to dolutegravir (DTG)-based antiretroviral therapy (ART) on estimated glomerular filtration rate (eGFR) in Asians are scarce. RV254/SEARCH010 is a prospective observational cohort in Bangkok, Thailand with ART initiation during acute HIV infection (AHI) where participants switched to DTG-based ART. Methods Participants started Efavirenz (EFV)-based ART during AHI (n = 214) and switched to DTG-based ART after a median of 97 weeks (IQR 61–145). GFR was estimated by serum creatinine (eGFRcre) every 24 weeks before and after switch. Estimated GFR by cystatin C (eGFRcystC) was ordered at clinician’s discretion for decreased eGFRcre after switch. Random-effect linear regression model was used to assess changes in eGFRcre over 96 weeks from starting ART, and from switching to DTG. Results At study entry, 20 participants (9.3%) had eGFRcre < 90 ml/min/1.73 m2. During EFV-based ART, an additional 17 (8%) developed eGFRcre < 90 ml/min/1.73 m2, nearly all transient, while mean eGFRcre remained stable and within normal range. At switch to DTG, 21 (9.8%) had eGFRcre < 90 ml/min/1.73 m2 but an additional 116 (54%) developed eGFRcre < 90 ml/min/1.73 m2 during follow-up with eGFRcre decrease being mostly persistent. Mean eGFRcre decreased 20.8% from 117.0 to 92.4 ml/min/1.73 m2 (p < 0.001). Among 20 post-switch participants with eGFRcystC measured within 4 weeks of eGFRcre < 90 mL/min/1.73 m2, 13 (65%) had normal kidney function by eGFRcystC. Conclusions Persistent eGFRcre decrease to < 90 ml/min/1.73 m2 after switch to DTG was common in this Thai population. eGFRcystC was helpful to identify individuals with clinically significant decrease in kidney function and obviate unnecessary ART modifications. Trial registration Clinical Trials Registry Number: ClininicalTrials.gov NCT00796146.
ISSN:1742-6405

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