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The clinical value of cystatin C as a marker of renal function in HIV patients receiving dolutegravir.

Research paper by Yusuke Y Yoshino, Ichiro I Koga, Kazunori K Seo, Takatoshi T Kitazawa, Yasuo Y Ota

Indexed on: 27 Jun '17Published on: 27 Jun '17Published in: AIDS research and human retroviruses



Abstract

Dolutegravir (DTG) is an integrase strand transfer inhibitor that is used for the treatment for human immunodeficiency virus (HIV) infection. DTG inhibits organic cation transporter 2 (OCT2) on the basolateral side of proximal tubule cells of the kidney, and leads to increased serum creatinine levels without true renal function deterioration. In HIV patients who receive DTG, an alternative test to serum creatinine measurement is needed to determine the correct renal function. We retrospectively evaluated 18 HIV-infected men who had received combination anti-retroviral therapy (cART), including DTG, and who had available data on serum creatinine and cystatin C levels. We used paired t-test to assess the changes in estimated glomerular filtration rate (eGFR) calculated by serum creatinine or cystatin C level, after the start of cART. In all 18 patients, only 2 cases were naïve, whereas 16 cases switched treatment. Based on serum creatinine level, eGFR significantly changed from 67.9 [61.2-95.7] mL/min per 1.73 m2 (medians and interquartile ranges [IQRs]) to 63.6 [55.5-83.7] mL/min per 1.73 m2 (P = 0.0004). Conversely, eGFR was almost unchanged (79.8 [77.7-82.5] to 80.0 [77.1-82.5] mL/min per 1.73 m2; P=0.132) when serum cystatin C level was used for estimation. In HIV patients receiving DTG, measurement of serum cystatin C as an alternative renal function test might be clinically valuable because it is not affected by DTG administration.