The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa.
BACKGROUND
The aim of this study was to assess, the efficacy and safety of add-on corticosteroids to antiretroviral therapy [ART] in patients with biopsy proven HIV associated nephropathy.


METHODS
All included patients had histological evidence of either collapsing or non-collapsing focal segmental glomerulosclerosis (FSGS) or podocyte and/or parietal cell hypertrophy or hyperplasia. All patients had evidence of tubulointerstitial inflammation with microcysts. Patients were randomized to ART with the addition of 1 mg/kg of corticosteroids [ART+C] or remained in the group [ART Alone] and followed for 2 years. A repeat biopsy was performed at 6 months.


RESULTS
Twenty-one patients were randomized to [ART+C] and 17 to [ART Alone]. The baseline estimated glomerular filtration rate (eGFR) was significantly lower in the [ART+C] vs. [ART Alone] group [35mls/min/1.73m2 vs. 47 mls/min/1.73m2, p = 0.015]. The [ART+C] cohort had a statistically significant improvement in median (eGFR) from baseline to last follow up compared with [ART Alone] i.e. [Δ = 25mls/min (IQR: 15;51) vs 9 mls/min (IQR: 0-24), p = 0.008]. There were no statistically significant differences between the groups when proteinuria and histology were analyzed. There were 8 deaths during the trial period, 7 from [ART+C] (Log rank p = 0.071).


CONCLUSIONS
In the [ART+C] cohort there was a significant improvement in eGFR over 2-years with increased mortality. Routine corticosteroid use cannot currently be recommended. Further investigation to define which subgroup of this cohort would safely benefit from the positive effects is required.


TRIAL REGISTRATION
ISRCTN study ID ( 56112439 ] was retrospectively registered on the 5 September 2018.
['Wearne|Nicola|N|0000-0001-9917-223X', 'Swanepoel|Charles R|CR|', 'Duffield|Maureen S|MS|', 'Davidson|Bianca J|BJ|', 'Manning|Kathryn|K|', 'Tiffin|Nicki|N|', 'Boulle|Andrew|A|', 'Rayner|Brian L|BL|', 'Naidu|Priyanka|P|', 'Okpechi|Ikechi G|IG|']
D016263:AIDS-Associated Nephropathy D000328:Adult D019380:Anti-HIV Agents D023241:Antiretroviral Therapy, Highly Active D001706:Biopsy D004359:Drug Therapy, Combination D005260:Female D005500:Follow-Up Studies D005919:Glomerular Filtration Rate D005923:Glomerulosclerosis, Focal Segmental D006801:Humans D053208:Kaplan-Meier Estimate D007668:Kidney D008297:Male D011241:Prednisone D011446:Prospective Studies D013019:South Africa D016896:Treatment Outcome D014376:Tuberculosis
Corticosteroids HIV HIV associated nephropathy