The effects of dolutegravir on creatinine clearance in children and adolescents living with HIV: a retrospective cohort study in Johannesburg

Abstract

Background: Dolutegravir (DTG) can result in serum creatinine (SC) elevation that should be less than 15% from the baseline and remain stable after initial rise. We wanted to explore whether DTG’s effects on SC were similar in our patients. Objectives: We investigated the effect of DTG on renal function and if there were any adverse renal effects when paired with tenofovir (TDF). Methods: Adolescents on anti-retroviral treatment were divided into the number of patients on TDF only, those that had started TDF prior to DTG, and the number of patients started on DTG prior to or concurrent with TDF. SC values were compared to reference ranges and glomerular filtration rate (GFR) was calculated using either the modification of diet in renal disease (MDRD) formula or the Counahan Barratt formula. The renal functioning for these patients was then separated into those that had significant renal dysfunction (GFR<80 in under 16-year-olds and <50 in over 16-year-olds). Results: The percentage change of SC between start of TDF and 12 months on TDF was > 15% in 50% cases. By 24 months of TDF 70% patients had >15% rise in SC, more so in the DTG concurrent group (p<0.0001). SC was above reference range in 4% at 12 months and 5% at 24 months while GFR was below recommended cut off in 3% at 12 and 24 months more so in adolescents also on DTG. 9 Conclusion: Our study showed that most of our patients had significant increases in SC, but few had significant renal dysfunction (low GFR), of note, many children had an increased GFR (glomerular hyperfiltration).