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Randomized Controlled Trial
. 2009 Jan 2;23(1):71-82.
doi: 10.1097/QAD.0b013e32831cc129.

Interruption of antiretroviral therapy is associated with increased plasma cystatin C

Amanda Mocroft  1 , Christina Wyatt, Lynda Szczech, Jacquie Neuhaus, Wafaa El-Sadr, Russell Tracy, Lewis Kuller, Michael Shlipak, Brian Angus, Harting Klinker, Michael Ross; INSIGHT SMART Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Interruption of antiretroviral therapy is associated with increased plasma cystatin C

Amanda Mocroft et al. AIDS. .

Abstract

Background: Cystatin C has been proposed as an alternative marker of renal function. We sought to determine whether participants randomized to episodic use of antiretroviral therapy guided by CD4 cell count (drug conservation) had altered cystatin C levels compared with those randomized to continuous antiretroviral therapy (viral suppression) in the Strategies for Management of Antiretroviral Therapy trial, and to identify factors associated with increased cystatin C.

Methods: Cystatin C was measured in plasma collected at randomization, 1, 2, 4, 8 and 12 months after randomization in a random sample of 249 and 250 participants in the drug conservation and viral suppression groups, respectively. Logistic regression was used to model the odds of at least 0.15 mg/dl increase in cystatin C (1 SD) in the first month after randomization, adjusting for demographic and clinical characteristics.

Results: At randomization, mean (SD) cystatin C level was 0.99 (0.26 mg/dl) and 1.01 (0.28 mg/dl) in the drug conservation and viral suppression arms, respectively (P = 0.29). In the first month after randomization, 21.8 and 10.6% had at least 0.15 mg/dl increase in cystatin C in the drug conservation and viral suppression arms, respectively (P = 0.0008). The difference in cystatin C between the treatment arms was maintained through 1 year after randomization. After adjustment, participants in the viral suppression arm had significantly reduced odds of at least 0.15 mg/dl increase in cystatin C in the first month (odds ratio 0.42; 95% confidence interval 0.23-0.74, P = 0.0023).

Conclusion: These results demonstrate that interruption of antiretroviral therapy is associated with an increase in cystatin C, which may reflect worsened renal function.

Trial registration: ClinicalTrials.gov NCT00027352.

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Figures

Figure 1
Figure 1
Cystatin C after randomisation in SMART
Figure 2
Figure 2
Odds ratio of >1 SD (0.15 mg/dl) increase in cystatin C by 1 month after randomisation to SMART
See this image and copyright information in PMC

References

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