The Clinical Value of Cystatin C as a Marker of Renal Function in HIV Patients Receiving Dolutegravir. (4th October 2017)

• Record Type: Journal Article
• Authors: Yoshino, Yusuke; Misu, Keita; Seo, Kazunori; Koga, Ichiro; Kitazawa, Takatoshi; Ota, Yasuo
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S220
• Page End: S220
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.450
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: In some studies, some of the formulated equations of GFR estimation based on serum cystatin C were shown to have no difference in bias and were accurate when compared with equations of GFR estimation based on iothalamate clearance. 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. Methods: 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 collected data on serum creatinine and cystatin C levels from two determinations: before, and one month to one year after administration of DTG. We using 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. Results: In all 18 patients, only 2 cases were naïve, whereas 16 cases switched treatment. For the 16 cases that switched treatment from protease inhibitors to single-tablet regimen of cART, the reasons were patient preference in 15 and progressive deterioration of renal function in 1. Based on serum creatinine level, eGFR significantly changed from 67.9 [61.2-95.7] mL/minute per 1.73 m 2 (medians and interquartile ranges [IQRs]) to 63.6 [55.5-83.7] mL/minute per 1.73 m 2 (P = 0.0004). Conversely, eGFR was almost unchanged (79.8 [77.7-82.5] to 80.0 [77.1–82.5] mL/minute per 1.73 m 2 ; P = 0.132) when serum cystatin C level was used for estimation. Conclusion: This study showed that DTG administration decreased eGFR calculated by serum creatinine, but did not affect eGFR calculated by serum cystatin C. This result suggested that measurement of cystatin C and eGFR calculated by serum cystatin C might be more clinically valuable than measurement of creatinine and eGFR calculated by serum creatnine in HIV patients receiving DTG. Disclosures: All authors: No reported disclosures.