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- Title
The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa.
- Authors
Wearne, Nicola; Swanepoel, Charles R.; Duffield, Maureen S.; Davidson, Bianca J.; Manning, Kathryn; Tiffin, Nicki; Boulle, Andrew; Rayner, Brian L.; Naidu, Priyanka; Okpechi, Ikechi G.
- Abstract
<bold>Background: </bold>The aim of this study was to assess, the efficacy and safety of add-on corticosteroids to antiretroviral therapy [ART] in patients with biopsy proven HIV associated nephropathy.<bold>Methods: </bold>All included patients had histological evidence of either collapsing or non-collapsing focal segmental glomerulosclerosis (FSGS) or podocyte and/or parietal cell hypertrophy or hyperplasia. All patients had evidence of tubulointerstitial inflammation with microcysts. Patients were randomized to ART with the addition of 1 mg/kg of corticosteroids [ART+C] or remained in the group [ART Alone] and followed for 2 years. A repeat biopsy was performed at 6 months.<bold>Results: </bold>Twenty-one patients were randomized to [ART+C] and 17 to [ART Alone]. The baseline estimated glomerular filtration rate (eGFR) was significantly lower in the [ART+C] vs. [ART Alone] group [35mls/min/1.73m2 vs. 47 mls/min/1.73m2, p = 0.015]. The [ART+C] cohort had a statistically significant improvement in median (eGFR) from baseline to last follow up compared with [ART Alone] i.e. [Δ = 25mls/min (IQR: 15;51) vs 9 mls/min (IQR: 0-24), p = 0.008]. There were no statistically significant differences between the groups when proteinuria and histology were analyzed. There were 8 deaths during the trial period, 7 from [ART+C] (Log rank p = 0.071).<bold>Conclusions: </bold>In the [ART+C] cohort there was a significant improvement in eGFR over 2-years with increased mortality. Routine corticosteroid use cannot currently be recommended. Further investigation to define which subgroup of this cohort would safely benefit from the positive effects is required.<bold>Trial Registration: </bold>ISRCTN study ID ( 56112439 ] was retrospectively registered on the 5 September 2018.
- Subjects
SOUTH Africa; CORTICOSTEROIDS; BK virus; FOCAL segmental glomerulosclerosis; PARIETAL cells; GLOMERULAR filtration rate; HIV; ART
- Publication
BMC Nephrology, 2019, Vol 20, Issue 1, p1
- ISSN
1471-2369
- Publication type
journal article
- DOI
10.1186/s12882-019-1208-2