The following is a summary of “Long-term impact of immediate versus deferred antiretroviral therapy on kidney health in people with HIV,” published in the April 2024 issue of Nephrology by Pelchen-Matthews et al.

Patients with HIV are at risk for chronic kidney disease (CKD) due to the virus itself and the antiretroviral therapy (ART) nephrotoxicity drugs used to treat it. Starting ART right away lowers mortality, However, its effects on kidney health in the long run are not well known. 

Researchers conducted a prospective study evaluating the impact of early versus delayed ART initiation on the risk of developing CKD in patients with HIV. 

They compared immediate versus deferred ART in adults going ART therapy  from the START (Strategic Timing of Antiretroviral Treatment) trial. Around 4,684 adults with HIV-positive virus and CD4 cell count under 500 cells/mm³ were split into 2 groups in which one group starting ART right away and the other waiting. Both the groups were followed for a median 9.3 years, and serious kidney problems or changes in kidney function (eGFR) and urine albumin/creatinine ratio (UACR) were assessed.

The results showed that after nearly a decade, only 8 participants had kidney failure or related deaths, where 3 initiated ART early and 5 delayed it. The annual rate of kidney function decline over 5 years was 1.19 mL/min/1.73m²/year, similar between those who started ART right away and those who waited (immediate arm 0.055; 95% CI -0.106, 0.217 mL/min/1.73m²). Even after adjusting for factors like UACR and APOL1, the results stayed consistent. There was no significant difference in the risk of kidney disease between the two groups in incidence of confirmed UACR 30 mg/g or more (odds ratio 1.13; 95% CI 0.85, 1.51).

Investigators concluded that initiating ART early seems safe for long-term kidney health in people with HIV and it doesn’t harm the kidneys over time.

Source: kidney-international.org/article/S0085-2538(24)00313-2/fulltext