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Dynamics of creatinine estimated glomerular filtration rate using one or more antiretrovirals that inhibit creatinine tubular secretion

2020; Oxford University Press; Volume: 76; Issue: 4 Linguagem: Inglês

10.1093/jac/dkaa547

1460-2091

María Jesús Pérez‐Elías, Belén Alejos, Maria Mar Gutierrez, Manuel Crespo, Ignacio de los Santos, Esteban Ribera, Marı́a José Galindo, Fernando Lozano, Antoni Payeras, Vicente Boix, Marta Montero, José Sanz, Javier de la Torre, Rosario Palacios, Sara de la Fuente Moral, Estebán Martínez, Pilar Callau, Santiago Ramón y Cajal, Ana Moreno, José L. Casado, Javier Martinez Sanchez, Cristina Gómez Ayerbe, Pilar Vizcarra, Santos del Campo, Eugènia Negredo, I Campos, Jordi Puig, Esteban Ribera, Ariadna Torrella, Bibiana Planas, Hernando Knobel, R Ferrando, Manuel Crespo, Antonio Ocampo, José Sanz, Ignacio de los Santos, A. Moreno, Alberto Díaz, Luz Martín‐Carbonero, Javier de la Torre, José María García de Lomas Guerrero, Mercedes Rivas Reina, Jesús Santos, Carmen María González-Domenech, Ma Mar Gutierrez, Marta Montero, Sandra Cuéllar, María Tasias, Iván Castro Hernández, Vicente Boix, Antoni Payeras, Pablo Ryan, Miguel Torralba, E. Ubiña Aznar, Herminia Esteban, Marta de Miguel, Paula González, María Yllescas,

HIV-related health complications and treatments

Cobicistat, dolutegravir and rilpivirine are all modest inhibitors of proximal tubular creatinine secretion (IPTCrS) and hence a moderate and early non-progressive creatinine estimated glomerular filtration rate (Cr-eGFR) reduction has been observed in clinical trials. Data regarding the impact of combination of those drugs on Cr-eGFR, in the clinical practice, are scarcely known.Changes in Cr-eGFR after starting darunavir/cobicistat alone or in combination with dolutegravir and/or rilpivirine were studied in a nationwide retrospective cohort study of consecutive HIV-infected patients initiating darunavir/cobicistat. The relationship between Cr-eGFR changes over time and the use of darunavir/cobicistat alone or darunavir/cobicistat plus dolutegravir and/or rilpivirine adjusted by different HIV patient's characteristics, socio-demographics, HIV severity and use of tenofovir concomitant medication other than antiretrovirals was explored through univariate and multivariate analyses.The analysis included 725 patients. At 48 weeks, the combination of two or more IPTCrS (darunavir/cobicistat with rilpivirine and/or dolutegravir) was associated with higher decreases in Cr-eGFR [adjusted median difference (±SD) -3.5 ± 1.6 (95% CI -6.6 to -0.3), P = 0.047], and a decrease up to or higher than 15 mL/min/1.73 m2 was more frequent [adjusted OR 3.233 (95% CI 1.343-7.782), P = 0.009], with respect to darunavir/cobicistat alone. The Cr-eGFR changes between darunavir/cobicistat and darunavir/cobicistat with rilpivirine and/or dolutegravir showed more significant decreases in patients taking two or more IPTCrS at 12, 24 and 48 weeks. (ClinicalTrials.gov: NCT03042390).Concomitant use of darunavir/cobicistat plus IPTCrS dolutegravir, rilpivirine, or both produced an additive effect in the expected Cr-eGFR decrease.