Glucose, urea, and creatinine laboratory tests in people starting antiretroviral therapy with dolutegravir or efavirenz: a cohort study in Belo Horizonte, Brazil
DOI:
https://doi.org/10.33448/rsd-v11i5.28541Keywords:
HIV treatment; Antiretroviral therapy; Dolutegravir; Efavirenz; Laboratory tests.Abstract
Goal: In this study, we aimed to monitor the blood glucose, urea, and creatinine laboratory tests in treatment-naive individuals, initiating ART with an antiretroviral regimen containing EFV or DTG, searching for a contribution to the understanding of the safety of these drugs in use in the real world, followed up for 72 weeks. Methods: Cohort study with a follow-up of people living with HIV initiating antiretroviral therapy. Results: An increase in blood creatinine levels at 24 and 48 weeks and blood glucose levels at 48 weeks (p=0.017) was observed in the group using Dolutegravir. Those using Efavirenz evidenced an increase in creatinine levels at 48 weeks (p=0.007), blood glucose levels at 72 weeks (p=0.009), and urea levels at 48 weeks (p=0.023). Being male (p=0.044) and having more than 13 schooling years (0.044) explained the change in creatinine levels. Tobacco use (p=0.006), illicit drug use (p=0.009), and schooling greater than or equal to 13 study years (p=0.038) were independently associated with changes in urea levels. The therapeutic regimen with Efavirenz (OR=8.20; 95% CI=1.32-51.05; p=0.024) and schooling greater than or equal to 13 study years were independently associated with increased blood glucose concentration. Conclusions: The DTG regimen was associated with increased serum creatinine levels for up to 42 weeks and was transient and returning to the levels observed before the start of ART. The Efavirenz regimen was related to increased serum glucose levels, and the Dolutegravir therapy was the preferred regimen.
References
Akkina, S. K., Ricardo, A. C., Patel, A., Das, A., Bazzano, L. A., Brecklin, C., ... & Lash, J. P. (2012). Illicit drug use, hypertension, and chronic kidney disease in the US adult population. Translational Research, 160(6), 391-398.
BRASIL. (2015). Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis. Brasília: Ministério da Saúde. Secretaria de Vigilância em Saúde.
BRASIL. (2017). Protocolo clínico e diretrizes terapêuticas para manejo da infecção pelo HIV em adultos: relatório de recomendações. Brasília: Ministério da Saúde. Secretaria de Vigilância em Saúde.
BRASIL. (2018a). Protocolo clínico e diretrizes terapêuticas para manejo da infecção pelo HIV em adultos. Brasília: Ministério da Saúde. Secretaria de Vigilância em Saúde.
BRASIL. (2018b). Protocolo Clínico e Diretrizes Terapêuticas para Manejo da Infecção pelo HIV em Crianças e Adolescentes. Brasília: Ministério da Saúde. Secretaria de Vigilância em Saúde.
BRASIL. (2020). Relatório de Monitoramento Clínico do HIV 2020. Brasília: Ministério da Saúde. Secretaria de Vigilância em Saúde.
Camargo, T. M., Rocha-Junior, D. S., Ferreira, S. R., Vasconcelos, E. M. A., Oliveira, S. J., Shitara, E. S., & Oshima-Franco, Y. (2006). Influência do tabagismo sobre as análises laboratoriais de rotina: um estudo piloto em adultos jovens. Revista de Ciências Farmacêuticas Básica e Aplicada, 27(3), 247-251.
Castro, A. D. C. O., Silveira, E. A., Falco, M. D. O., Nery, M. W. & Turchi, M. D. (2016). Overweight and abdominal obesity in adults living with HIV/AIDS. Revista da Associação Médica Brasileira, 62(1), 353-360.
Carrapato, P., Correia, P. & Garcia, B. (2017). Determinante da saúde no Brasil: a procura da equidade na saúde. Saúde e Sociedade, 26(3), 676-689.
Cattaneo, D., Sollima, S., Meraviglia, P., Milazzo, L., Minisci, D., Fusi, M., Filice, C. & Gervasoni, C. (2020). Dolutegravir‑based antiretroviral regimens for hiv liver transplant patients in real‑life settings. Drugs in R&D, 20(1), 155-160.
Cysne, A. C., Torga, E. D. G. C., Luzia, E. L., Lemos, L. M. C., Souza, L. M. S., Rocha, M. A. P., M. C. Siqueira, S. B. & Resende, S. E. (2016). Manual de Exames Laboratoriais da rede SUS-BH. Belo Horizonte: Prefeitura Municipal de Belo Horizonte.
Dooley, K. E., Kaplan, R., Mwelase, N., Grinsztejn, B., Ticona, E., Lacerda, M., ... & Aboud, M. (2020). Dolutegravir-based antiretroviral therapy for patients coinfected with tuberculosis and human immunodeficiency virus: a multicenter, noncomparative, open-label, randomized trial. Clinical Infectious Diseases, 70(4), 549-556.
Dusse, L. M. S., Rios, D. R. A., Sousa, L. P. N., Moraes, R. M. M. S., Domingueti, C. P. & Gomes, K. B. (2016). Biomarcadores da função renal: do que dispomos atualmente. Revista Brasileira de Análise Clínicas, 49(1), 41-51.
Erlandson, K. M., Kitch, D., Tierney, C., Sax, P. E., Daar, E. S., Melbourne, K. M., ... & McComsey, G. A. (2014). Impact of randomized antiretroviral therapy initiation on glucose metabolism: AIDS clinical trials group study A5224s. AIDS, 28(10), 1451-1461.
Gardner, L. I., Klein, R. S., Szczech, L. A., Phelps, R. M., Tashima, K., Rompalo, A. M., ... & Holmberg, S. D. (2003). Rates and risk factors for condition-specific hospitalizations in HIV-infected and uninfected women. Journal of Acquired Immune Deficiency Syndromes, 34(3), 320-330.
Joshi, K., Boettiger, D., Kerr, S., Nishijima, T., Van Nguyen, K., Ly, P. S., ... & Pujari, S. (2018). Changes in renal function with long‐term exposure to antiretroviral therapy in HIV‐infected adults in Asia. Pharmacoepidemiology and Drug Safety, 27(1), 1209-1216.
Kaboré, N. F.; Poda, A.; Zoungrana, J.; Da, O.; Ciaffi, L.; Semdé, A.; Yaméogo, I.; Sawadogo, A. B.; Delaporte, E.; Meda, N.; Limou, S. & Cournil, A. (2019). Chronic kidney disease and HIV in the era of antiretroviral treatment: findings from a 10-year cohort study in a West African setting. BMC Nephrology, 20(155), 1-10.
Kolakowska, A., Maresca, A. F., Collins, I. J. & Cailhol, J. (2019). Update on adverse effects of HIV integrase inhibitors. Current Treatment Options in Infectious Diseases, 11(1), 372-387.
Martínez, E., Arnaiz, J. A., Podzamczer, D., Dalmau, D., Ribera, E., Domingo, P., ... & Gatell, J. M. (2003). Substitution of nevirapine, Efavirenz, or abacavir for protease inhibitors in patients with human immunodeficiency virus infection. New England Journal of Medicine, 349(11), 1036-1046.
Mclaughlin, M. M., Guerrero, A. J. & Merker, A. (2018). Renal effects of non-tenofovir antiretroviral therapy in patients living with HIV. Drugs Context, 7(1), 01-15.
Mendes, J. C., Bonolo, P. D. F., Ceccato, M. D. G. B., Costa, J. D. O., Reis, A. M. M., Dos Santos, H., & Silveira, M. R. (2018). Adverse reactions associated with first-line regimens in patient initiating antiretroviral therapy. European Journal of Clinical Pharmacology, 74(8), 1077-1088.
Milburn, J., Jones, R. & Levy, J. B. (2017). Renal effects of novel antiretroviral drugs. Nephrology Dialysis Transplantation, 32(1), 434-439.
Minas Gerais. (2018). Boletim epidemiológico mineiro: análise epidemiológica de HIV/aids. Panorama do ano de 2017. Belo Horizonte: Secretaria Estadual de Saúde.
Nyende, L.; Kalyesubula, R.; Sekasanvu, E. & Byakika-Kibwika, P. (2020). Prevalence of renal dysfunction among HIV infected patients receiving Tenofovir at Mulago: a cross-sectional study. BMC Nephrology, 22(1), 1-6.
Oliveira, O. C. A. D., Oliveira, R. A. D. & Souza, L. D. R. D. (2011). Impacto do tratamento antirretroviral na ocorrência de macrocitose em pacientes com HIV/AIDS do município de Maringá, Estado do Paraná. Revista da Sociedade Brasileira de Medicina Tropical, 44(1), 35-39.
Orth, S. R. (2004). Effects of smoking on systemic and intrarenal hemodynamics: influence on renal function. Journal of the American Society of Nephrology, 15(1 suppl), S58-S63.
Peres, L. A. B., Cunha Júnior, A. D. D., Schäfer, A. J., Silva, A. L. D., Gaspar, A. D., Scarpari, D. F., ... & Oliveira, T. F. T. D. (2013). Biomarcadores da injúria renal aguda. Brazilian Journal of Nephrology, 35(3), 229-236.
Pinto Neto, L. F. S., Braga, A. C., Rocha, J. A., Vieira, N. F. R. & Miranda, A. E. (2011). Fatores de risco associados a alterações renais em pacientes infectados por HIV-1. Revista da Sociedade Brasileira de Medicina Tropical, 44(1), 30-34.
Redig, A. J. & Berliner, N. (2013). Pathogenesis and clinical implications of HIV-related anemia in 2013. Hematology, 2013(1), 377-381.
Ronit, A., Lundgren, J., Afzal, S., Benfield, T., Roen, A., Mocroft, A., ... & Nielsen, S. D. (2018). Airflow limitation in people living with HIV and matched uninfected controls. Thorax, 73(5), 431-438.
Tsuda, L. C., Silva, M. M., Machado, A. A. & Fernandes, A. P. M. (2012). Alterações corporais: terapia antirretroviral e síndrome da lipodistrofia em pessoas vivendo com HIV/AIDS. Revista Latino-Americana Enfermagem, 20(5), 01-07.
Teixeira, L. D. S. L., Ceccato, M. D. G. B., Carvalho, W. D. S., Costa, J. D. O., Bonolo, P. D. F., Mendes, J. C., & Silveira, M. R. (2020). Prevalência e fatores associados ao tabagismo em pessoas vivendo com HIV em tratamento. Revista de Saúde Pública, 54, 108.
Vieira, T. S., Vieira, I. S., Bresser, M., Moura, L. C. L. & Moura, M. A. (2018). O papel do dolutegravir na terapia antirretroviral. HU Revista, 44 (3), 379-385.
WHO. (2018). Informação interna perguntas e respostas sobre o uso de dolutegravir (DTG) por mulheres em Idade reprodutiva 21 de Maio de 2018. https://www.who.int/hiv/mediacentre/news/q-a-dtg_Pt.pdf?ua=1
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Copyright (c) 2022 Jorgino Julio Cesar; Micheline Rosa Silveira; Cléssius Ribeiro de Souza; Henrique Pereira de Aguilar Penido; Ana Cristina da Silva Fernandes; Maria das Graças Braga Ceccato
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