Changes in proteinuria and albuminuria with initiation of antiretroviral therapy: Data from a randomized trial comparing tenofovir disoproxil fumarate/emtricitabine versus abacavir/lamivudine

Christina M. Wyatt, Douglas Kitch, Samir K. Gupta, Camlin Tierney, Eric S. Daar, Paul E. Sax, Belinda Ha, Kathleen Melbourne, Grace A. McComsey

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: Antiretroviral therapy (ART) is associated with improved kidney function; however, the nucleotide reverse transcriptase inhibitor (NRTI) tenofovir disoproxil fumarate (TDF) has been associated with decreased kidney function and proteinuria. Methods: We examined changes in urine protein:creatinine (UPCR) and urine albumin:creatinine (UACR) ratios in 245 ART-naive participants in A5202 randomized in a substudy to blinded NRTI (abacavir/lamivudine, ABC/3TC, n = 124 or TDF/emtricitabine, TDF/FTC, n = 121) with open-label protease inhibitor (PI) atazanavir/ritonavir or nonnucleoside reverse transcriptase inhibitor (NNRTI) efavirenz. Results: At baseline, 18% of participants had clinically significant proteinuria (UPCR 200 mg/g), and 11% had clinically significant albuminuria (UACR 30 mg/g). The prevalence of clinically significant proteinuria and albuminuria decreased from baseline to week 96 in all treatment groups. In intention-to-treat analyses, there was a significant effect of NRTI component on fold change in UPCR (P = 0.011) and UACR (P = 0.018) from baseline to week 96, with greater improvements in participants randomized to ABC/3TC. There was no significant effect of NNRTI/PI component on fold change in UPCR (P = 0.23) or UACR (P = 0.88), and no significant interactions between NRTI and NNRTI/PI components. Conclusions: In this prespecified secondary analysis, ART initiation was associated with improvements in proteinuria and albuminuria, with significantly greater improvements in participants randomized to ABC/3TC versus TDF/FTC. These are the first data from a randomized trial to suggest that initiation of TDF/FTC may not be associated with the same degree of improvement in proteinuria and albuminuria that have been reported with other regimens. Future studies should consider the long-term clinical significance of these findings.

Original languageEnglish (US)
Pages (from-to)36-44
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume67
Issue number1
DOIs
StatePublished - Sep 1 2014

Keywords

  • antiretroviral therapy
  • HIV
  • kidney disease

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Medicine(all)

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