Cargando…

High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya

BACKGROUND: There is a paucity of data on kidney impairment among older people living with HIV (PLWH). We evaluated kidney function among PLWH age ≥ 60 years on first-line antiretroviral (ARV) therapy during screening for a clinical trial in Kenya. METHODS: The bictegravir/emtricitabine/tenofovir al...

Descripción completa

Detalles Bibliográficos
Autores principales: Penner, Jeremy, Ombajo, Loice Achieng, Otieno, Davies, Nkuranga, Joseph, Mburu, Margaret, Wahome, Simon, Pozniak, Anton, Bhagani, Sanjay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10289444/
https://www.ncbi.nlm.nih.gov/pubmed/37352206
http://dx.doi.org/10.1371/journal.pone.0285787
_version_ 1785062279854686208
author Penner, Jeremy
Ombajo, Loice Achieng
Otieno, Davies
Nkuranga, Joseph
Mburu, Margaret
Wahome, Simon
Pozniak, Anton
Bhagani, Sanjay
author_facet Penner, Jeremy
Ombajo, Loice Achieng
Otieno, Davies
Nkuranga, Joseph
Mburu, Margaret
Wahome, Simon
Pozniak, Anton
Bhagani, Sanjay
author_sort Penner, Jeremy
collection PubMed
description BACKGROUND: There is a paucity of data on kidney impairment among older people living with HIV (PLWH). We evaluated kidney function among PLWH age ≥ 60 years on first-line antiretroviral (ARV) therapy during screening for a clinical trial in Kenya. METHODS: The bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) Elderly Study is an open-label, randomized, active-controlled, non-inferiority trial conducted at two sites in Kenya. Potential participants were screened for study entry if they were at least 60 years old, had been on ARVs for at least 24 weeks and had no history of treatment failure. At screening, participants had samples collected for serum creatinine and estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration 2021 equation. RESULTS: Between January and April 2022, 714 participants were screened and had creatinine measured. All participants were black, 54.1% were female and the median age was 64 years (range 60 to 87 years). Most participants (666 [93.3%]) were on tenofovir disoproxil fumarate-containing regimens, 711 (99.6%) were on dolutegravir-containing regimens, and only 2 (0.3%) were on a regimen with a ritonavir-boosted protease inhibitor. Most participants (686 [96.6%]) were virally suppressed. Treatment for comorbidities was common, with 175 (24.5%) on treatment for hypertension and 39 (5.5%) on treatment for diabetes mellitus. The median eGFR was 64.7 mL/min/1.73m(2), and 289 (40.5%) participants had an eGFR < 60 mL/min/1.73m(2). In multivariate analysis, factors associated with lower eGFR were female gender (p<0.001), being on treatment for hypertension (p<0.001) and nadir CD4 count < 50 cells/μL (p = 0.008). CONCLUSIONS: Our study identified high rates of impaired kidney function among elderly PLHW in Kenya, which highlights the importance of routine assessment of kidney function and the need to address modifiable risk factors, use of appropriate ARVs, and management of kidney disease in this population.
format Online
Article
Text
id pubmed-10289444
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-102894442023-06-24 High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya Penner, Jeremy Ombajo, Loice Achieng Otieno, Davies Nkuranga, Joseph Mburu, Margaret Wahome, Simon Pozniak, Anton Bhagani, Sanjay PLoS One Research Article BACKGROUND: There is a paucity of data on kidney impairment among older people living with HIV (PLWH). We evaluated kidney function among PLWH age ≥ 60 years on first-line antiretroviral (ARV) therapy during screening for a clinical trial in Kenya. METHODS: The bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) Elderly Study is an open-label, randomized, active-controlled, non-inferiority trial conducted at two sites in Kenya. Potential participants were screened for study entry if they were at least 60 years old, had been on ARVs for at least 24 weeks and had no history of treatment failure. At screening, participants had samples collected for serum creatinine and estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration 2021 equation. RESULTS: Between January and April 2022, 714 participants were screened and had creatinine measured. All participants were black, 54.1% were female and the median age was 64 years (range 60 to 87 years). Most participants (666 [93.3%]) were on tenofovir disoproxil fumarate-containing regimens, 711 (99.6%) were on dolutegravir-containing regimens, and only 2 (0.3%) were on a regimen with a ritonavir-boosted protease inhibitor. Most participants (686 [96.6%]) were virally suppressed. Treatment for comorbidities was common, with 175 (24.5%) on treatment for hypertension and 39 (5.5%) on treatment for diabetes mellitus. The median eGFR was 64.7 mL/min/1.73m(2), and 289 (40.5%) participants had an eGFR < 60 mL/min/1.73m(2). In multivariate analysis, factors associated with lower eGFR were female gender (p<0.001), being on treatment for hypertension (p<0.001) and nadir CD4 count < 50 cells/μL (p = 0.008). CONCLUSIONS: Our study identified high rates of impaired kidney function among elderly PLHW in Kenya, which highlights the importance of routine assessment of kidney function and the need to address modifiable risk factors, use of appropriate ARVs, and management of kidney disease in this population. Public Library of Science 2023-06-23 /pmc/articles/PMC10289444/ /pubmed/37352206 http://dx.doi.org/10.1371/journal.pone.0285787 Text en © 2023 Penner et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Penner, Jeremy
Ombajo, Loice Achieng
Otieno, Davies
Nkuranga, Joseph
Mburu, Margaret
Wahome, Simon
Pozniak, Anton
Bhagani, Sanjay
High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya
title High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya
title_full High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya
title_fullStr High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya
title_full_unstemmed High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya
title_short High rates of kidney impairment among older people (≥ 60 years) living with HIV on first-line antiretroviral therapy at screening for a clinical trial in Kenya
title_sort high rates of kidney impairment among older people (≥ 60 years) living with hiv on first-line antiretroviral therapy at screening for a clinical trial in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10289444/
https://www.ncbi.nlm.nih.gov/pubmed/37352206
http://dx.doi.org/10.1371/journal.pone.0285787
work_keys_str_mv AT pennerjeremy highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya
AT ombajoloiceachieng highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya
AT otienodavies highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya
AT nkurangajoseph highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya
AT mburumargaret highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya
AT wahomesimon highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya
AT pozniakanton highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya
AT bhaganisanjay highratesofkidneyimpairmentamongolderpeople60yearslivingwithhivonfirstlineantiretroviraltherapyatscreeningforaclinicaltrialinkenya