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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BMC
2025-02-01
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| Series: | AIDS Research and Therapy |
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| Online Access: | https://doi.org/10.1186/s12981-025-00712-0 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Carlo Sacdalan |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-9bf3db75e87c4fc992f4d6e76da77c40 |
| institution | Kabale University |
| issn | 1742-6405 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | AIDS Research and Therapy |
| spelling | doaj-art-9bf3db75e87c4fc992f4d6e76da77c402025-02-09T12:55:18ZengBMCAIDS Research and Therapy1742-64052025-02-012211710.1186/s12981-025-00712-0Impaired creatinine-based estimated glomerular filtration rate in Thai individuals switching to dolutegravir: illustrating the role of cystatin C testing to aid clinical decision makingCarlo Sacdalan0Curtis Austin1Aswathy Varma2Suteeraporn Pinyakorn3Eugène Kroon4Donn J. Colby5Phillip Chan6Orlanda Goh7Krittaporn Pornpaisakul8Jintana Intasan9Tassanee Luekasemsuk10Merlin L. Robb11Nitiya Chomchey12Nittaya Phanuphak13Jintanat Ananworanich14Sandhya Vasan15Denise Hsu16the SEARCH 010/RV254 study groupSEARCH Research FoundationWashington University School of Medicine in St. LouisMedicine and Surgery, University of MilanUnited States Military HIV Research Program; Walter Reed Army Institute of ResearchSEARCH Research FoundationUnited States Military HIV Research Program; Walter Reed Army Institute of ResearchDepartment of Neurology, Yale UniversitySEARCH Research FoundationSEARCH Research FoundationSEARCH Research FoundationSEARCH Research FoundationUnited States Military HIV Research Program; Walter Reed Army Institute of ResearchSEARCH Research FoundationInstitute of HIV Research and InnovationAmsterdam UMC, Department of Global Health, Amsterdam Institute for Global Health and DevelopmentUnited States Military HIV Research Program; Walter Reed Army Institute of ResearchUnited States Military HIV Research Program; Walter Reed Army Institute of ResearchAbstract 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.https://doi.org/10.1186/s12981-025-00712-0Glomerular filtration rateHIV infectionRenal insufficiencyCreatinineCystatin CDolutegravir |
| spellingShingle | 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 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 AIDS Research and Therapy Glomerular filtration rate HIV infection Renal insufficiency Creatinine Cystatin C Dolutegravir |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Glomerular filtration rate HIV infection Renal insufficiency Creatinine Cystatin C Dolutegravir |
| url | https://doi.org/10.1186/s12981-025-00712-0 |
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