Cystatin C-based renal function changes after antiretroviral initiation: A substudy of a randomized trial

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

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8 Scopus citations


Background. The effects of antiretrovirals on cystatin C-based renal function estimates are unknown. Methods. We analyzed changes in renal function using creatinine and cystatin C-based estimating equations in 269 patients in A5224s, a substudy of study A5202, in which treatment-naive patients were randomized to abacavir/lamivudine or tenofovir/emtricitabine with open-label atazanavir/ritonavir or efavirenz. Results. Changes in renal function significantly improved (or declined less) with abacavir/lamivudine treatment compared with tenofovir/emtricitabine using the Cockcroft-Gault formula (P =.016) and 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI; P =.030) and 2012 CKD-EPI cystatin C-creatinine (P =.025). Renal function changes significantly improved (or declined less) with efavirenz compared with atazanavir/ritonavir (P <.001 for all equations). Mean (95% confidence interval) renal function changes specifically for tenofovir/emtricitabine combined with atazanavir/ritonavir were -8.3 (-14.0, -2.6) mL/min with Cockcroft-Gault; -14.9 (-19.7, -10.1) mL/min per 1.732 with Modification of Diet in Renal Disease; -12.8 (-16.5, -9.0) mL/min per 1.732 with 2009 CKD-EPI; +8.9 (4.2, 13.7) mL/min per 1.732 with 2012 CKD-EPI cystatin C; and -1.2 (-5.1, 2.6) mL/min per 1.732 with 2012 CKD-EPI cystatin C-creatinine. Renal function changes for the other treatment arms were more favorable but similarly varied by estimating equation. Conclusions. Antiretroviral-associated changes in renal function vary in magnitude and direction based on the estimating equation used.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Issue number1
StatePublished - 2014



  • Atazanavir
  • Creatinine
  • Cystatin C
  • HIV-1
  • Nephropathy
  • Tenofovir

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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