Impact of early antiretroviral therapy on kidney disease outcomes

项目摘要 HIV感染与慢性肾脏病（CKD）的风险增加有关。很少有人知道的 HIV和抗逆转录病毒治疗（ART）对无症状HIV患者CKD的影响。我们假设 在CD 4+细胞计数高的患者中立即开始ART将导致早期改善， CKD的临床相关标志物，但早期肾脏获益将被长期 暴露于当前一线ART治疗方案，具有确定的肾毒性潜力。我们将测试这个 在一项辅助研究中的假设，以战略时机的抗逆转录病毒治疗（START）试验， 一项随机试验，研究早期与延迟ART对初治患者的影响， CD 4> 500个细胞/mm 3。START的随机设计提供了一个独特的机会，可以直接比较 开始ART的HIV感染者之间肾功能和肾损伤标志物的变化 立即在高CD 4和ART延迟的类似个体中。前瞻性文件 估计肾小球滤过率和存档血浆和尿液样本的可用性将使我们能够 评价立即ART对临床相关CKD结局的影响，并细化现有风险 用于预测HIV阳性高CD 4个体中CKD的评分。

Project Abstract HIV infection is associated with an increased risk of chronic kidney disease (CKD). Little is known about the contribution of HIV and antiretroviral therapy (ART) to CKD in asymptomatic HIV. We hypothesize that immediate initiation of ART in patients with high CD4+ cell counts will result in early improvements in clinically relevant markers of CKD, but that the early renal benefits will be partially offset by prolonged exposure to current first-line ART regimens with established nephrotoxic potential. We will test this hypothesis in an ancillary study to the Strategic Timing of AntiRetroviral Treatment (START) trial, a randomized trial investigating the impact of early versus deferred ART in treatment-naïve individuals with CD4 > 500 cells/mm3. The randomized design of START offers a unique opportunity to directly compare the change in kidney function and markers of kidney injury between HIV-infected individuals who initiate ART immediately at high CD4 and similar individuals in whom ART is deferred. The prospective documentation of estimated glomerular filtration rate and availability of archived plasma and urine specimens will allow us to evaluate the impact of immediate ART on clinically relevant CKD outcomes and to refine existing risk scores for the prediction of CKD in HIV-positive individuals with high CD4.