Chronic kidney disease in patients infected with human immunodeficiency virus (HIV) in an urban cohort.

Authors:
Duc T Nguyen
Duc T Nguyen
University of Missouri-Columbia
United States
Eric J Lai
Eric J Lai
College of Physicians & Surgeons
Toronto | Canada
Angelina M Albert
Angelina M Albert
Community Education at Methodist Hospital
Ann S Barnes
Ann S Barnes
University of Texas Medical School at Houston
United States
Edward A Graviss
Edward A Graviss
Houston Methodist Research Institute
Houston | United States

PLoS One 2019 17;14(4):e0215575. Epub 2019 Apr 17.

Nephrology Training Program at Houston Methodist Hospital, Houston, Texas, United States of America.

Background And Objectives: HIV-infected patients are at risk for developing chronic kidney disease (CKD), defined by estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2. Our purpose was to understand the genesis of CKD in HIV patients from a large urban clinic in Houston, Texas, USA, and to characterize progression of CKD in the cohort.

Design, Setting, Participants And Measurements: A retrospective cohort study (2012-2016) was conducted in all HIV-infected patients seen in a federally qualified community health center in Houston, Texas. CKD prevalence and its association with HIV viral load and CD4 count were determined. The association of the change in eGFR over time and comorbidities was assessed using linear mixed models.

Results: Of 3714 HIV-infected patients analyzed, 153 (4.1%) had CKD. The prevalence of CKD in the different racial groups was 5.4% White, 4.0% African American, 2.8% Hispanic/Latino and 3.2% Asian. There was no difference in the rate of decline in kidney function in White vs. African American HIV infected patients with CKD. Compared with non-CKD patients, CKD patients were older, had lived longer with HIV infection, had lower CD4 cell counts, higher proportions of hypertension, hyperlipidemia, and cerebrovascular disease, and had significantly higher rates of eGFR deterioration represented by a median decrease of 26.5% from first to last follow-up eGFR (versus 0% change). Linear mixed modeling identified older age, male gender, White race, longer time with HIV infection, hypertension, history of kidney stones, cerebrovascular disease, autoimmune disease, increased potassium and total cholesterol levels, and being treated with combination ART as associated with a worsening eGFR over time.

Conclusion: This study demonstrates a prevalence of CKD in HIV-infected patients of 4.1% and points to an important role for HIV medications and other common comorbidities in the genesis and progression of kidney disease. Importantly, CKD was not more prevalent in African Americans than in Whites, perhaps due to a low prevalence of IV drug abuse as inferred from the lower prevalence of HCV infection in this cohort.

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Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215575PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469809PMC
April 2019
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References

(Supplied by CrossRef)
Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome
TK Rao et al.
N Engl J Med 1984
Anti-HIV drugs: 25 compounds approved within 25 years after the discovery of HIV
E De Clercq et al.
International Journal of Antimicrobial Agents 2009
Polymorphisms associated with renal adverse effects of antiretroviral therapy in a Southern Brazilian HIV cohort
IM Da Rocha et al.
Pharmacogenetics and Genomics 2015
Renal insufficiency in Ghanaian HIV infected patients: Need for dose adjustment
WK Owiredu et al.
African Health Sciences 2013
Renal effect of novel antiretroviral drugs
J Milburn et al.
Nephrol Dial Transplant 2017

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