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- W2943435578 abstract "Many large prospective paediatric cohort studies have successfully demonstrated the clinical safety and benefits of antiretroviral therapy (ART) use in HIV-infected children and adolescents. In these studies, monitoring of significant adverse events including renal function was extensively conducted and they did not demonstrate reductions in renal function associated with ART, particularly when regimens not containing tenofovir disoproxil fumarate (TDF) or older protease inhibitors such as indinavir were evaluated 1-3. HIV-associated nephropathy tends to improve following ART initiation, and can be largely prevented with early ART initiation 4. In light of this, we were surprised by the findings reported by Tadesse et al., 5 which showed a dramatic decrease in glomerular filtration rate (GFR) of 35.6 mL/min/1.73 m2 in Ethiopian children after 6 months of ART, particularly because TDF use was very limited in this cohort. We believe that these unusual findings may be explained by a methodological problem in GFR estimation. This formula does not account for height, and therefore a normal creatinine increase attributable to aging and growth results in a factitious decline in eGFR. We encourage the authors to reanalyse their data using a paediatric height-based calculation such as the Schwartz formula or Counahan–Barratt formula, as the use of an adult GFR estimation tool may have significantly impacted their results. The findings of this study have significant implications for paediatric HIV programmes in many developing countries where limited resources are available for laboratory monitoring. In these settings, decisions regarding laboratory monitoring require prioritization. For this reason, potentially unnecessary renal laboratory monitoring could adversely impact ART scale-up initiatives, as programmes could prioritize renal laboratory assessments over HIV-1 virus load monitoring, for example. It is therefore crucial to re-evaluate the findings with the use of age-appropriate GFR assessment tools to further the development of optimal monitoring guidelines." @default.
- W2943435578 created "2019-05-09" @default.
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- W2943435578 date "2019-04-29" @default.
- W2943435578 modified "2023-09-27" @default.
- W2943435578 title "Letter to Editor:<scp>HIV</scp>medicine" @default.
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- W2943435578 doi "https://doi.org/10.1111/hiv.12743" @default.
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