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Asmelash D, Nigatie M. Chronic kidney disease and its associated factors in HIV-infected individuals: a comparison of antiretroviral therapy naïve and experienced patients. Front Med (Lausanne) 2024; 11:1455688. [PMID: 39588184 PMCID: PMC11586211 DOI: 10.3389/fmed.2024.1455688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 10/25/2024] [Indexed: 11/27/2024] Open
Abstract
Background Chronic kidney disease (CKD) has emerged as one of the primary comorbidity affecting individuals infected with human immunodeficiency virus (HIV), even after the initiation of highly active antiretroviral therapy (HAART). The main objective of this study was to assess the prevalence of CKD and its associated factors among HIV-infected individuals who are HAART naïve compared to those who are HAART experienced. Methods An institution-based cross-sectional study was conducted at Mizan Tepi University Comprehensive Specialized Hospital from March to May 2022. A double population proportion formula was used to select 250 study participants, with 125 being HAART naïve and 125 being HAART experienced. Socio-demographic and clinical data were collected using a semi-structured questionnaire. Serum creatinine levels were measured using a Mindray BS-200 chemistry analyzer, and the estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The level of urine protein was measured using a reagent strip within 30 min of collection. Descriptive statistics, independent t-tests, and multivariable logistic regression analysis were performed, with a p-value of <0.05 considered statistically significant. Result The mean (±SD) age of the HAART-naïve individuals was 35 ± 9.5, while that of the HAART-experienced individuals was 45 ± 9.9 years. Of the total participants, 67.2% participants were women. The overall prevalence of CKD among the HIV-infected study participants was 36.4%. The prevalence of CKD was 33.6% in HAART-naïve individuals and 39.2% in HAART-experienced individuals, with a p-value of 0.03. Male sex was identified as an independent factor associated with CKD in this study. Conclusion The prevalence of CKD was found to be higher among HAART-experienced individuals than HAART-naïve individuals. Regular renal function assessments should be conducted before and during HAART to mitigate the risk of renal dysfunction.
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Affiliation(s)
- Daniel Asmelash
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Marye Nigatie
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Abdel-Hameed EA, Overton ET. What's up with the decline in beans? Are there simple tests to identify people with HIV at risk for chronic kidney disease? AIDS 2024; 38:917-919. [PMID: 38578961 DOI: 10.1097/qad.0000000000003869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | - Edgar T Overton
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- ViiV Healthcare Medical Affairs, Durham, NC, USA
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Schinas G, Schinas I, Ntampanlis G, Polyzou E, Gogos C, Akinosoglou K. Bone Disease in HIV: Need for Early Diagnosis and Prevention. Life (Basel) 2024; 14:522. [PMID: 38672792 PMCID: PMC11051575 DOI: 10.3390/life14040522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The transformation of HIV into a manageable chronic condition has unveiled new clinical challenges associated with aging-related pathologies, including bone disease. This review explores the intricate relationship between HIV, antiretroviral therapy (ART), and bone disease, highlighting the necessity of early diagnosis and preventative strategies to mitigate the increased risk of osteopenia, osteoporosis, and fractures in people living with HIV (PLWHIV). It synthesizes the current literature to elucidate the multifactorial etiology of bone pathology in this population, that includes direct viral effects, chronic immune activation, ART-associated risks, and the impact of traditional risk factors for bone loss. Through a critical examination of modern diagnostic methods, lifestyle modifications, evidence-based preventive actions, and pharmacological treatments, the necessity for comprehensive management is highlighted, along with recommendations for integrated healthcare approaches vital for achieving optimal patient outcomes. By advocating for a proactive, patient-centered, and multidisciplinary strategy, this review proposes a plan to integrate bone health into standard HIV care through active risk identification, vigilant screening, effective preventive measures, tailored treatments, and informed decision-making, in an effort to ultimately enhance the quality of life for PLWHIV.
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Affiliation(s)
- Georgios Schinas
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Ioannis Schinas
- School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Georgios Ntampanlis
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Eleni Polyzou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Charalambos Gogos
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
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Mascolo S, Romanelli A. A new frontier in HIV care: the predictive power of renal biomarkers on heart health. AIDS 2024; 38:595-596. [PMID: 38416550 DOI: 10.1097/qad.0000000000003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Silvia Mascolo
- AO dei Colli, Cotugno Hospital, Infectious Diseases and Gender Medicine Unit, Naples
| | - Antonio Romanelli
- AOU San Giovanni di Dio e Ruggi D'Aragona, Department of Anaesthesia and Intensive Care, Salerno, Italy
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Alsaeed A, Alhaddad MJ, Alkhalifah RH, Abu Shaigah FA, Alshehab MM, Alali ZH, Ebrahim SH, Abdulla HM, Al Ibraheem GA, Al Bensaad GA, Alaliw WA, Alsheef HJ, Altriki MY, Alkhalaf AA. Prevalence of Chronic Kidney Disease in People Living With HIV Following in Dammam Medical Complex, Saudi Arabia. Cureus 2024; 16:e51947. [PMID: 38333467 PMCID: PMC10852097 DOI: 10.7759/cureus.51947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Backgrounds People living with human immunodeficiency virus (HIV) are at a greater risk of chronic kidney disease (CKD) compared to people not having HIV. Evaluating the prevalence of CKD in people living with HIV in Dammam, Saudi Arabia was the main objective of this study. Methods This cross-sectional study included adult HIV patients who were followed at Dammam Medical Complex. The patients' demographic data, comorbid conditions, and HIV history were reviewed from their electronic medical records. Results A total of 729 patients were counted. The glomerular filtration rate (GFR) of 235 patients could not be estimated. The data for the remaining 494 patients were analyzed. The cohort consisted of 406 male patients (82.19%) and 88 female patients (17.81%). The mean ± standard deviation for the patients' age and HIV duration were 39.08±10.93 years and 4.37±3.15 years, respectively. Ten patients (2.02%) had a GFR of <60 mL/min/1.73 m2. Among 136 patients who had an estimated GFR of ≥60 mL/min/1.73 m2 and were tested by a urine examination, 27 patients (19.85%) had albuminuria. Combining the two figures resulted in an estimated prevalence of CKD in HIV patients of 21.47%. Only one patient (0.02%) was receiving dialysis. Conclusions The prevalence of CKD in people living with HIV in Dammam, Saudi Arabia was higher than the general population. The findings highlight the elevated risk of CKD among people living with HIV and emphasize the importance of regular monitoring and early detection of kidney dysfunction in this population.
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Affiliation(s)
- Ali Alsaeed
- Infectious Disease, Dammam Medical Complex, Dammam, SAU
| | | | | | | | | | - Zahra H Alali
- College of Medicine, Mansoura University, Mansoura, EGY
| | | | | | | | | | - Welaa A Alaliw
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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GAO H, ZHANG J, YANG X, CHEN S, MATHEW R, WEISSMAN S, OLATOSI B, LI X. The incidence and dynamic risk factors of chronic kidney disease among people with HIV. AIDS 2023; 37:1783-1790. [PMID: 37467049 PMCID: PMC10529259 DOI: 10.1097/qad.0000000000003662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVES We investigate the incidence of chronic kidney disease (CKD) among people with HIV (PWH) and the dynamic risk factors associated with CKD incidence. DESIGN A population-based cohort study of PWH in South Carolina. METHODS Adults (age ≥18 years) PWH diagnosed between 2006 and 2019 who were CKD-free at baseline were included. The associations of HIV-related risk factors and conventional risk factors with the incidence of CKD were investigated during the overall study period and by different follow-up periods (i.e. 5, 10, and 15 years) by multivariate logistic regression. RESULTS Among 9514 PWH, the incidence of CKD was 12.39 per 1000 person-years. The overall model indicated that conventional risk factors, such as hypertension, dyslipidemia, cardiovascular disease, and diabetes, were significantly associated with a higher risk of developing CKD. HIV-related characteristics, such as high percentage of days with viral suppression, recent CD4 + cell count, and percentage of retention in care, were associated with a lower risk of CKD compared with their counterparts. In the subgroup analysis, the results were similar for the 5-year and 6-10 years follow-up groups. Among patients who did not develop CKD by the 10th year, the risk factors for developing CKD within 11-15 years were dyslipidemia, diabetes, low recent CD4 + cell count, and short duration of retention in care while other predictors vanished. CONCLUSION Diabetes, CD4 + cell count, and retention in care were persistently associated with CKD despite of follow-up duration. Closely monitoring diabetes and improving CD4 + cell count and retention in care are important to lower the risk of CKD in PWH.
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Affiliation(s)
- Haoyuan GAO
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Jiajia ZHANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xueying YANG
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie CHEN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Roy MATHEW
- Division of Nephrology, Department of Medicine Loma Linda VA Health Care System. Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Sharon WEISSMAN
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole OLATOSI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming LI
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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Reis AO, Rocco Suassuna JH, Cunha CB, Portela EN, Veloso VG, Grinszteijn B, Cardoso SW. Evaluation of Glomerular Filtration Rate Trends in People Living With HIV Corrected by the Baseline Glomerular Filtration Rate. J Acquir Immune Defic Syndr 2023; 94:82-90. [PMID: 37276245 DOI: 10.1097/qai.0000000000003232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Chronic kidney disease, for which estimated glomerular filtration rate (eGFR) trajectories are early markers, is frequent in people living with HIV. SETTING Identify eGFR trajectory patterns according to kidney function and assess associated factors over a 13-year follow-up period. METHODS We evaluated longitudinal changes and its associated factors in eGFR of 3366 participants according to kidney function with a 2-level, linear, mixed model. RESULTS Participants with initial kidney dysfunction experienced a slight eGFR increase, whereas others showed a slight decrease. A weak relationship was observed between baseline eGFR and its variation over time. Baseline eGFR was affected by age, CD4 + count, viral load, hypertension, hyperlipidemia, AIDS-defining illness and tenofovir (TDF) with integrase inhibitor (INSTI) or efavirenz. Significant factors for eGFR change included the following: in kidney dysfunction, CD4 + cell count of >350 cells per cubic millimeter and undetectable viral load increased eGFR, whereas TDF + protease inhibitor decreased eGFR; in mildly decreased kidney function, CD4 + cell count of >350 cells per cubic millimeter, AIDS-defining illness, and TDF + efavirenz increased eGFR, whereas age, hypertension, hyperlipidemia, and TDF + INSTI decreased eGFR; in normal kidney function, age, CD4 + cell count of > 350 cells per cubic millimeter, undetectable viral load, hypertension, hyperlipidemia, and TDF + INSTI decreased eGFR, whereas TDF + efavirenz increased eGFR (all P value for interaction < 0.05). CONCLUSION Our findings suggest that eGFR trajectories varied widely between individuals in people living with HIV. In the lower eGFR group, virus-related factors were more relevant, whereas traditional risk factors for renal dysfunction were more prominent in the highest eGFR group.
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Affiliation(s)
- Amanda Orlando Reis
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
- Clínical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José H Rocco Suassuna
- Clínical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cynthia B Cunha
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Estevão N Portela
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Valdilea G Veloso
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Beatriz Grinszteijn
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Sandra Wagner Cardoso
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
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Garimella PS, Scherzer R, Kestenbaum BR, Hoofnagle AN, Jotwani V, Gustafson D, Karim R, Sharma A, Cohen M, Dumond J, Abraham A, Estrella M, Shlipak MG, Ix JH. Tubular Secretory Solute Clearance and HIV Infection. J Acquir Immune Defic Syndr 2023; 93:319-326. [PMID: 36988544 PMCID: PMC10313730 DOI: 10.1097/qai.0000000000003200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 12/05/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Tubular secretion is an important kidney function responsible for the clearance of numerous medications, including antibiotics and antivirals. It is unknown whether persons living with HIV have lower secretion compared with HIV-uninfected persons, which might predispose them to the risk of progressive kidney disease or adverse drug events. SETTING AND METHODS We evaluated a panel of 6 endogenous secretory solutes in 199 women living with HIV (WLWH) and 100 women without HIV enrolled in the Women's Interagency HIV Study. Secretory clearance was estimated as the urine-to-plasma ratio of each solute, with adjustment for urine tonicity. Using multivariable linear regression analysis, we compared differences in levels of secretory solute clearance between women with and without HIV and evaluated characteristics associated with secretion. RESULTS WLWH were older (median 40 vs. 38 years) but had similar estimated glomerular filtration rate (eGFR, 96 vs. 100 mL/minute/1.73 m 2 ) compared with those without HIV. African American and Latino race, diabetes, diastolic blood pressure, smoking, hepatitis C, peak HIV viral load, and current and nadir CD4 count were associated with differences in clearance of at least 1 marker after multivariable adjustment. The secretory clearance of 3 solutes (cinnamoylglycine, kynurenic acid, and pyridoxic acid) were on average 10%-15% lower among WLWH compared with those without HIV independent of eGFR, albuminuria and chronic kidney disease risk factors, including HCV, and injection drug use. CONCLUSIONS HIV is associated with reduced secretion among women with preserved eGFR. The implications of these findings for drug dosing and adverse events need to be evaluated.
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Affiliation(s)
- Pranav S. Garimella
- Kidney Research Innovation Hub of San Diego and Division of Nephrology and Hypertension, University of California San Diego, San Diego, USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
| | | | - Andrew N. Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Vasantha Jotwani
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Medical Center, New York, NY, USA
| | - Roksana Karim
- Department of Clinical Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mardge Cohen
- Stroger Hospital of Cook County Health and Human Services, Chicago, IL, USA
| | - Julie Dumond
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Alison Abraham
- Department of Epidemiology, University of Colorado School of Public Health, Denver, CO, USA
| | - Michelle Estrella
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Joachim H. Ix
- Kidney Research Innovation Hub of San Diego and Division of Nephrology and Hypertension, University of California San Diego, San Diego, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Isac R, Costa R, Frandes M, Lazureanu VE, Stroescu RF, Steflea RM, Bagiu IC, Horhat FG, Chicin GN, Roberta AC, Cornelia PA, Doros G, Gafencu M. Renal Impairment Impact and Survival Analysis in a Romanian Cohort of HIV-1(F1)-Infected Children and Adolescents. Life (Basel) 2023; 13:life13040888. [PMID: 37109416 PMCID: PMC10143557 DOI: 10.3390/life13040888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Human immunodeficiency virus (HIV) is a lentivirus that is transmissible through blood and other body fluids. During the late 1980s and early 1990s, an estimated 10,000 Romanian children were infected with HIV-1 subtype F nosocomially through contaminated needles and untested blood transfusions. Romania was a special case in the global acquired immunodeficiency syndrome (AIDS) pandemic, displaying the largest population of HIV-infected children by parental transmission between 1987–1990. In total, 205 HIV-infected patients from the western part of Romania were analyzed in this retrospective study. Over 70% of them had experienced horizontal transmission from an unknown source, while vertical transmission was identified in only five cases. Most patients had a moderate to severe clinical manifestation of HIV infection, 77.56% had undergone antiretroviral (ARV) treatment, most of them (71.21%) had experienced no adverse reactions and many of those with HIV (90.73%) had an undetectable viral load. Renal impairment was detected in one third of patients (34.63%). Patients born before 1990, male patients, patients diagnosed with HIV before the age of 10, and those undernourished or with renal impairment had a shorter average survival time than the group born after 1990, female patients, patients receiving ARV treatment, patients with a normal body mass index (BMI) and those without renal impairment. Periodical monitoring of the estimated glomerular filtration rate (eGFR) level, as well as the detection of protein excretion, should be taken into consideration worldwide when monitoring HIV-positive patients; this in order to detect even asymptomatic chronic kidney disease (CKD), and to manage these patients and prolong their lives.
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Alvarez E, Campbell L, Tinago W, Garcia-Leon A, Walsh I, Brady JJ, Burling K, Noe S, Neuville MF, Jouret F, Jamshidian F, Graham H, Rhee M, Mallon PW, Post FA. The renal-bone axis in older people living with HIV on stable antiretroviral therapy: A sub-analysis of the GS-US-104-0423 study. Antivir Ther 2022; 27:13596535221094898. [PMID: 36000318 DOI: 10.1177/13596535221094898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data on low bone mineral density (BMD) in people living with HIV (PLWH) are mainly derived from younger adults; little is known about how antiretroviral therapy (ART) and alterations in the renal-bone axis relate to BMD in older PLWH. METHODS Cross-sectional study of men > 50 years and post-menopausal women with HIV. Antiretroviral therapy exposure was stratified into four groups based on use of tenofovir disoproxil fumarate (TDF) and protease inhibitors (PI): non-TDF/non-PI, non-TDF/PI, TDF/non-PI, and TDF/PI. Bone mineral density was measured by dual X-ray absorptiometry (DXA). Bone turnover/regulatory markers and renal tubular function were analysed in stored plasma and urine samples. The association of ART exposure and bone/renal biomarkers on BMD was explored using logistic regression models. RESULTS 247 individuals (median [IQR] age 57 [53, 65] years; 47% female; 13% of Black ethnicity; CD4 count 643 [473, 811] cells/mm3; and 98% with HIV RNA < 200 copies/mL) were included. Bone turnover and renal tubular function differed significantly by ART exposure. In analyses adjusted for demographic and traditional renal/bone risk factors, exposure to TDF and PI was associated with a fourfold greater risk of low BMD at the femoral neck and exposure to TDF and/or PI with a threefold greater risk of low BMD at the lumbar spine. The relationship between ART and low BMD was not altered by further adjustment for bone turnover or renal tubular function markers. CONCLUSIONS The associations between low BMD and ART exposure (TDF vs. non-TDF and boosted vs. unboosted third agents) were minimally affected by adjustments for bone and kidney biomarkers.
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Affiliation(s)
- Elena Alvarez
- Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
| | | | - Willard Tinago
- Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
| | - Alejandro Garcia-Leon
- Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
| | - Ian Walsh
- 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Sebastian Noe
- MVZ Karlsplatz HIV Research and Clinical Care Center, Munich, Germany
| | - Marie F Neuville
- Laboratory of Translational Research in Nephrology, ULiege GIGA Research Center, Liege, Belgium
| | - Francois Jouret
- Laboratory of Translational Research in Nephrology, ULiege GIGA Research Center, Liege, Belgium
| | | | - Hiba Graham
- 2158Gilead Sciences, Inc., Foster City, CA, USA
| | - Martin Rhee
- 2158Gilead Sciences, Inc., Foster City, CA, USA
| | - Paddy W Mallon
- Centre for Experimental Pathogen Host Research, 8797University College Dublin School of Medicine, Dublin, Ireland
| | - Frank A Post
- 4616Kings College London, London, UK.,8948King's College Hospital NHS Foundation Trust, London, UK
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Qin F, Lv Q, Hong W, Wei D, Huang K, Lan K, Chen R, Liu J, Liang B, Liang H, Liang H, Qin S, Ye L, Jiang J. Association Between CD4/CD8 Ratio Recovery and Chronic Kidney Disease Among Human Immunodeficiency Virus-Infected Patients Receiving Antiretroviral Therapy: A 17-Year Observational Cohort Study. Front Microbiol 2022; 13:827689. [PMID: 35222339 PMCID: PMC8867036 DOI: 10.3389/fmicb.2022.827689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND CD4/CD8 ratio is considered as an emerging biomarker for human immunodeficiency virus (HIV)-related diseases. However, the relationship of CD4/CD8 ratio recovery and chronic kidney disease (CKD), and whether cumulative antiretroviral therapy (ART) is effective in the CD4/CD8 ratio recovery and in reducing CKD incidence among HIV patients remain unclear. METHODS A 17-year observational cohort study was conducted on all HIV-infected patients receiving ART in Guangxi, China. Kaplan-Meier analysis was used to investigate the cumulative CKD incidence. Cox regression and propensity score matching (PSM) were used to evaluate the association between CD4/CD8 ratio recovery and CKD incidence, and the effect of ART regimens on CD4/CD8 ratio recovery and CKD incidence. RESULTS A total of 59,268 eligible individuals contributing 285,143 person-years of follow-up, with an overall CKD incidence of 9.65%. After ART, patients who developed CKD showed higher mortality than those with normal kidney function (12.48 vs. 7.57%, p < 0.001). Patients whose CD4/CD8 ratio did not recover to 0.7 had a higher CKD incidence than the patients who recovered (aHR = 2.84, 95% CI 2.63-3.07), similar to the PSM analysis (aHR = 3.13, 95% CI 2.85-3.45). Compared with the PI-based and INSTI-based regimens, NNRTI-based regimen had a better CD4/CD8 ratio recovery rate (27.04, 16.16, and 29.66%, respectively) and a lower CKD incidence (17.43, 16.16, and 7.31%, respectively). CONCLUSION This large-scale real-world setting provide new evidence that the CD4/CD8 ratio recovery is associated with lower CKD incidence in HIV-infected patients receiving ART. NNRTI-based is a better choice for CD4/CD8 ratio recovery and reducing the risk of CKD.
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Affiliation(s)
- Fengxiang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Qing Lv
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Wen Hong
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China
| | - Di Wei
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Kui Huang
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Ke Lan
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Rongfeng Chen
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Jie Liu
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China
| | - Huayue Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Shanfang Qin
- Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, China
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12
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Negredo E, Loste C, Puig J, Echeverría P, Fumaz CR, Muñoz-Moreno JA, Lemos B, Martínez A, Tamayo F, Saiz M, Estany C, Matarrodona M, Bonjoch A, Blanco N, Satorra P, Clotet B. Accentuated aging associated with HIV in a Mediterranean setting occurs mainly in persons aged>70 years: a comparative cohort study (Over50 cohort). AIDS Care 2021; 34:155-162. [PMID: 34743624 DOI: 10.1080/09540121.2021.1998314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In an ongoing Mediterranean cohort, we compared age-related conditions between 208 HIV-infected persons and 104 matched controls. ≥3 comorbidities were found in 31.0% of HIV-infected patients and 8.7% of controls. Conditions significantly more frequent among the HIV-infected population were: lipid abnormalities, cancer, osteopenia/osteoporosis, liver disease, sexual dysfunction, hearing deficit, sleep disorders, falls, cognitive complaints, being single, living alone, and being elderly at risk. HIV-infected patients aged >70 years had a significantly higher number of cardiovascular risk factors (CVRF) and comorbidities than controls. HIV-infected persons who had never smoked had a higher prevalence of CVRFs, ≥3 comorbidities, liver disease, cancer, and cognitive complaints compared to controls. Factors associated with frailty were being a man who has sex with men, ≥3 CVRFs, nadir CD470 years. The multidisciplinary assessment also revealed concerning findings in social, cognitive, and functional variables among HIV-infected individuals, with a higher prevalence of elderly at risk than among controls.
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Affiliation(s)
- Eugenia Negredo
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Cora Loste
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Jordi Puig
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Patricia Echeverría
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carmina R Fumaz
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jose A Muñoz-Moreno
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Begoña Lemos
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ana Martínez
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Fauri Tamayo
- Cap Rambla, Hospital Universitari Mutua Terrassa, Barcelona, Spain
| | | | - Carla Estany
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Anna Bonjoch
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Pau Satorra
- Biostatistics Unit, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Bonaventura Clotet
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain.,AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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13
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Malformative Reno-Urinary Pathology in Patients with HIV Infection-Clinical and Therapeutic Implications. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2020-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Chronic kidney disease is an important comorbidity of HIV infection causing real problems in the evolution and medical healthcare of HIV-positive patients. In recent years, a significant number of HIV-positive patients develop renal dysfunction, several mechanisms being incriminated: direct effect of the virus, toxic effect secondary to of antiretroviral medication, secondary to associated comorbidities, given that life expectancy has increased significantly in the last decade, thanks to the use of antiretroviral therapies. There are few studies in the literature to evaluate malformative renourinary pathology in patients with HIV infection. We present the case of a patient with HIV infection, horseshoe kidney, chronic kidney disease and incomplete Fanconi syndrome, secondary to the administration of tenofovir fumarate, a nucleoside reverse transcriptase inhibitor. Malformations, abnormalities or dysmorphysms of the renal tract should be considered in the HIV-positive patient with secondary renal dysfunction because they take a wide range of forms, are underdiagnosed and predispose to multiple complications, with varying degrees of severity, such as urinary tract infections, renal stones or progression of chronic kidney disease. Tenofovir fumarate and atazanavir must be avoided in patients with HIV infection and chronic renal dysfunction.
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14
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Blanco JR, Negredo E, Bernal E, Blanco J. Impact of HIV infection on aging and immune status. Expert Rev Anti Infect Ther 2020; 19:719-731. [PMID: 33167724 DOI: 10.1080/14787210.2021.1848546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Thanks to antiretroviral therapy (ART), persons living with HIV (PLWH), have a longer life expectancy. However, immune activation and inflammation remain elevated, even after viral suppression, and contribute to morbidity and mortality in these individuals.Areas covered: We review aspects related to immune activation and inflammation in PLWH, their consequences, and the potential strategies to reduce immune activation in HIV-infected individuals on ART.Expert opinion: When addressing a problem, it is necessary to thoroughly understand the topic. This is the main limitation faced when dealing with immune activation and inflammation in PLWH since there is no consensus on the ideal markers to evaluate immune activation or inflammation. To date, the different interventions that have addressed this problem by targeting specific mediators have not been able to significantly reduce immune activation or its consequences. Given that there is currently no curative intervention for HIV infection, more studies are necessary to understand the mechanism underlying immune activation and help to identify potential therapeutic targets that contribute to improving the life expectancy of HIV-infected individuals.
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Affiliation(s)
- Jose-Ramon Blanco
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Pedro- Centro De Investigación Biomédica De La Rioja (CIBIR), La Rioja, Spain
| | - Eugenia Negredo
- Lluita Contra La Sida Foundation, Germans Trias I Pujol University Hospital, Badalona, Spain. Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (Uvic - UCC), Catalonia, Spain
| | - Enrique Bernal
- Unidad De Enfermedades Infecciosas, Hospital General Universitario Reina Sofía, Universidad De Murcia, Murcia, Spain
| | - Juliá Blanco
- AIDS Research Institute-IrsiCaixa, Badalona, Barcelona, Spain.,Universitat De Vic-Central De Catalunya (UVIC-UCC), Vic, Spain
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15
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Sutton SS, Magagnoli J, Hardin JW, Hsu LI, Beaubrun A, Majethia S, Cummings TH. Association of tenofovir disoproxil fumarate exposure with chronic kidney disease and osteoporotic fracture in US veterans with HIV. Curr Med Res Opin 2020; 36:1635-1642. [PMID: 32856940 DOI: 10.1080/03007995.2020.1816538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF)-based regimens have been associated with impaired kidney function and loss of bone mineral density among patients living with HIV (PLWH). We assess the association between TDF exposure and the odds of chronic kidney disease (CKD) and osteoporotic fracture in HIV patients. METHODS Demographics, administrative claims, and pharmacy dispensation were extracted from the Veterans Affairs Informatics and Computing Infrastructure (VINCI). Patients were categorized based on TDF utilization. Incidence rates for patients exposed and unexposed to TDF were calculated per 1000 patient-years (PYs). Logistic regression was used to calculate the odds of outcome after adjusting for baseline and clinical characteristics. RESULTS The sample included 4,630 PLWH who were currently exposed to TDF and 1,181 who were never exposed to TDF for the CKD analyses. For fracture analyses, the sample included 6,883 PLWH who were currently exposed to TDF and 1,951 who were never exposed to TDF. In adjusted models, current TDF exposure was associated with increased odds of CKD compared to never having been exposed (OR: 1.48, 95% CI: 1.18-1.85). Odds of fracture were 2.32 times higher for patients who were currently on a TDF regimen (OR: 2.32, 95% CI: 1.58-3.42) compared to those who had never been exposed to TDF in adjusted models. CONCLUSIONS In a large cohort of US veterans with HIV, current exposure to TDF was associated with a 48% higher odds of CKD and a greater than two-fold increase in the odds of osteoporotic fracture.
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Affiliation(s)
- S Scott Sutton
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
| | - Joseph Magagnoli
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
| | - James W Hardin
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ling-I Hsu
- Gilead Sciences Inc., Foster City, CA, USA
| | | | | | - Tammy H Cummings
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
- WJB Dorn Veterans Affairs Medical Center, Dorn Research Institute, Columbia, SC, USA
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16
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Ando M, Ando Y. A high likelihood of increase in end-stage renal disease among the Japanese HIV-infected population. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0245-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractKidneys are affected by human immunodeficiency virus (HIV) infection and its associated therapies. Antiretroviral therapy (ART) has markedly reduced acquired immune deficiency syndrome–related deaths and opportunistic infectious diseases among HIV-infected patients. This contributed to their prolonged survival; however, the improvement in survival has been accompanied by an increase in the incidence of non-infectious chronic complications, including hypertension, metabolic diseases, and chronic kidney disease (CKD). Recent studies showed that estimated prevalence of any CKD and end-stage renal disease (ESRD) among HIV-infected patients is approximately 20% and 0.5%, respectively, in Japan. Both a rapid decrease in renal function and a high positive rate of albuminuria and proteinuria are clinical characteristics of HIV-infected patients. Moreover, considering higher complication rates of hypertension and diabetes compared with non-HIV-infected individuals of the similar aging, HIV-infected patients who develop CKD and ESRD are very likely to increase. Furthermore, as the survival rate is favorable after the initiation of dialysis, the cumulative number of ESRD patients is supposed to increase. The corporation for treatment of HIV-positive hemodialysis patients by general dialysis clinics will be urgently required; however, there still remain some preoccupations and prejudices about HIVper sein Japan, which may provoke hesitation from accepting those patients.
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17
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Petersen N, Knudsen AD, Mocroft A, Kirkegaard-Klitbo D, Arici E, Lundgren J, Benfield T, Oturai P, Nordestgaard BG, Feldt-Rasmussen B, Nielsen SD, Ryom L. Prevalence of impaired renal function in virologically suppressed people living with HIV compared with controls: the Copenhagen Comorbidity in HIV Infection (COCOMO) study. HIV Med 2019; 20:639-647. [PMID: 31359592 DOI: 10.1111/hiv.12778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES While renal impairment is reported more frequently in people living with HIV (PLWH) than in the general population, the PLWH samples in previous studies have generally been dominated by those at high renal risk. METHODS Caucasian PLWH who were virologically suppressed on antiretroviral treatment and did not have injecting drug use or hepatitis C were recruited from the Copenhagen Comorbidity in HIV Infection (COCOMO) study. Sex- and age-matched controls were recruited 1:4 from the Copenhagen General Population Study up to November 2016. We defined renal impairment as one measurement of estimated glomerular filtration rate ≤ 60 mL/min/1.73 m2 , and assessed associated factors using adjusted logistic regression models. The impact of HIV-related factors was explored in a subanalysis. RESULTS Among 598 PLWH and 2598 controls, the prevalence of renal impairment was 3.7% [95% confidence interval (CI) 2.3-5.5%] and 1.7% (95% CI 1.2-2.2%; P = 0.0014), respectively. After adjustment, HIV status was independently associated with renal impairment [odds ratio (OR) 3.4; 95% CI 1.8-6.3]. In addition, older age [OR 5.4 (95% CI 3.9-7.5) per 10 years], female sex [OR 5.0 (95% CI 2.6-9.8)] and diabetes [OR 2.9 (95% CI 1.3-6.7)] were strongly associated with renal impairment. The association between HIV status and renal impairment became stronger with older age (P = 0.02 for interaction). Current and nadir CD4 counts, duration of HIV infection and previous AIDS-defining diagnosis were not associated with renal impairment among virologically suppressed PLWH. CONCLUSIONS The prevalence of renal impairment is low among low-risk virologically suppressed Caucasian PLWH, but remains significantly higher than in controls. Renal impairment therefore remains a concern in all PLWH and requires ongoing attention.
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Affiliation(s)
- N Petersen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - A D Knudsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | | | - E Arici
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - J Lundgren
- Department of Infectious Diseases, CHIP, Center of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T Benfield
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - B G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Copenhagen General Population Study and Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - B Feldt-Rasmussen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S D Nielsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - L Ryom
- Department of Infectious Diseases, CHIP, Center of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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18
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Yanagisawa N, Muramatsu T, Koibuchi T, Inui A, Ainoda Y, Naito T, Nitta K, Ajisawa A, Fukutake K, Iwamoto A, Ando M. Prevalence of Chronic Kidney Disease and Poor Diagnostic Accuracy of Dipstick Proteinuria in Human Immunodeficiency Virus-Infected Individuals: A Multicenter Study in Japan. Open Forum Infect Dis 2018; 5:ofy216. [PMID: 30320149 PMCID: PMC6176335 DOI: 10.1093/ofid/ofy216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has become one of the common comorbid conditions affecting the human immunodeficiency virus (HIV) population. Human immunodeficiency virus-infected individuals are at increased risk of developing CKD, and they are likely to experience faster progression of renal dysfunction compared with HIV-uninfected individuals. Albuminuria represents not only kidney damage but also manifests metabolic syndrome and vascular dysfunction. METHODS We conducted a multicenter, cross-sectional study involving 2135 HIV-infected individuals in Japan to test the prevalence of CKD and proteinuria/albuminuria. Urine sample was analyzed by both dipstick test and albumin-to-creatinine ratio (ACR) assay. Chronic kidney disease was classified according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The diagnostic performance of dipstick test to detect albuminuria (ACR ≥30 mg/g) was evaluated. RESULTS The prevalence of CKD, evaluated by K/DOQI and KDIGO guidelines, was 15.8% and 20.4%, respectively. Age, total cholesterol level, prevalence of hypertension, diabetes mellitus, and hepatitis C infection tended to increase, whereas levels of hemoglobin, serum albumin, and CD4 cell count tended to decrease as CKD risk grades progressed. Proteinuria and albuminuria were present in 8.9% and 14.5% of individuals, respectively. Dipstick test ≥1+ to detect albuminuria had an overall sensitivity of 44.9% and specificity of 97.2%. CONCLUSIONS The KDIGO guideline may enable physicians to capture HIV-infected patients at increased risk more effectively. The sensitivity of dipstick proteinuria to detect albuminuria is so poor that it may not serve as an alternative in HIV-infected individuals.
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Affiliation(s)
- Naoki Yanagisawa
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takashi Muramatsu
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Tomohiko Koibuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Akihiro Inui
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yusuke Ainoda
- Division of Infection Control and Infectious Diseases, Mitsui Memorial Hospital, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kosaku Nitta
- Department IV of Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Atsushi Ajisawa
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
- Department of Medicine, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, Tokyo, Japan
| | - Katsuyuki Fukutake
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Aikichi Iwamoto
- Division of Infectious Diseases, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Minoru Ando
- Department IV of Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Medicine, Jiseikai Memorial Hospital, Tokyo, Japan
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19
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Matłosz B, Pietraszkiewicz E, Firląg-Burkacka E, Grycner E, Horban A, Kowalska JD. Risk factors for kidney disease among HIV-1 positive persons in the methadone program. Clin Exp Nephrol 2018; 23:342-348. [PMID: 30218298 DOI: 10.1007/s10157-018-1644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Kidney injury is a serious comorbidity among HIV-infected patients. Intravenous drug use is listed as one of the risk factors for impaired renal function; however, this group is rarely assessed for specific renal-related risks. METHODS Patients attending methadone program from 1994 to 2015 were included in the study. Data collected included demographic data, laboratory tests, antiretroviral treatment history, methadone dosing and drug abstinence. Patients' drug abstinence was checked monthly on personnel demand. We have evaluated two study outcomes: (1) having at least one or (2) three eGFR < 60 ml/min (MDRD formula). RESULTS In total, 267 persons, with 2593 person-years of follow-up were included into analyses. At the time of analyses, 251 (94%) were on antiretroviral therapy (ARV). Fifty-two (19.5%) patients had 1eGFR and 20 (7.5%) 3eGFR < 60. In univariate analysis, factors significantly increasing the odds of impaired renal function were: female gender, detectable HIV RNA on ART, age at registration per 5 years older, atazanavir use and time on antiretroviral treatment per 1 year longer. In the multivariate model, only female gender (OR 4.7; p = 0.002), time on cART (OR 1.11; p = 0.01) and baseline eGFR (OR 0.71; p = 0.001) were statistically significant. CONCLUSIONS We have demonstrated a high rate of kidney function impairment among HIV-1 positive patients in the methadone program. All risk factors for decreased eGFR in this subpopulation of patients were similar to those described for general HIV population with very high prevalence in women. These findings imply the need for more frequent kidney function monitoring in this subgroup of patients.
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Affiliation(s)
- Bartłomiej Matłosz
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland.
| | - Ewa Pietraszkiewicz
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Ewa Firląg-Burkacka
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Ewa Grycner
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Andrzej Horban
- Department for Adults Infectious Diseases, Medical University of Warsaw, ul. Wolska 37, 01-201, Warsaw, Poland
| | - Justyna D Kowalska
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, ul. Wolska 37, 01-201, Warsaw, Poland.,Department for Adults Infectious Diseases, Medical University of Warsaw, ul. Wolska 37, 01-201, Warsaw, Poland
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20
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Johs NA, Wu K, Tassiopoulos K, Koletar SL, Kalayjian RC, Ellis RJ, Taiwo B, Palella FJ, Erlandson KM. Disability Among Middle-Aged and Older Persons With Human Immunodeficiency Virus Infection. Clin Infect Dis 2018; 65:83-91. [PMID: 28369402 DOI: 10.1093/cid/cix253] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/17/2017] [Indexed: 01/03/2023] Open
Abstract
Background Older human immunodeficiency virus (HIV)-infected adults may experience higher rates of frailty and disability than the general population. Improved understanding of the prevalence, risk factors, and types of impairment can better inform providers and the healthcare system. Methods HIV-infected participants within the AIDS Clinical Trials Group A5322 HAILO study self-reported disability by the Lawton-Brody Instrumental Activities of Daily Living (IADL) Questionnaire. Frailty was measured by 4-m walk time, grip strength, self-reported weight loss, exhaustion, and low activity. Logistic regression models identified characteristics associated with any IADL impairment. Agreement between IADL impairment and frailty was assessed using the weighted kappa statistic. Results Of 1015 participants, the median age was 51 years, 15% were aged ≥60 years, 19% were female, 29% black, and 20% Hispanic. At least 1 IADL impairment was reported in 18% of participants, most commonly with housekeeping (48%) and transportation (36%) and least commonly with medication management (5%). In multivariable models, greater disability was significantly associated with neurocognitive impairment, lower education, Medicare/Medicaid insurance (vs private/other coverage), smoking, and low physical activity. Although a greater proportion of frail participants had IADL impairment (52%) compared to non-frail (11%) persons, agreement was poor (weighted kappa <0.18, 95% confidence interval, 0.13, 0.23). Conclusion IADL disability occurs frequently among middle-aged and older HIV-infected adults on effective antiretroviral therapy. Potentially modifiable risk factors (smoking, physical activity) provide targets for interventions to maintain independent living. Systematic recognition of persons at greater risk for disability can facilitate connection to resources that may help preserve independence.
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Affiliation(s)
- Nikolas A Johs
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| | - Kunling Wu
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Susan L Koletar
- Department of Internal Medicine, Ohio State University, Columbus
| | - Robert C Kalayjian
- Department of Medicine, MetroHealth and Louis Stokes Cleveland Veterans Administration Medical Center, Ohio
| | - Ronald J Ellis
- Department of Neurosciences, University of California-San Diego
| | - Babafemi Taiwo
- Department of Medicine,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank J Palella
- Department of Medicine,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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21
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Park J, Zuñiga JA. Chronic Kidney Disease in Persons Living with HIV: A Systematic Review. J Assoc Nurses AIDS Care 2018; 29:655-666. [PMID: 29751988 DOI: 10.1016/j.jana.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
Abstract
The purpose of our systematic review of research on chronic kidney disease (CKD) in persons living with HIV (PLWH) was to (a) compare and contrast diagnostic criteria for CKD, (b) identify risk factors of CKD in PLWH, and (c) elucidate the prevalence of CKD in PLWH. Keyword searches of PubMed and PsycInfo databases were followed by manual searches of references from 2000 through 2016; 21 studies met inclusion criteria. Sample sizes ranged from 8 to 15,140, with a mean age of 50 years, and represented diverse ethnicities/races and countries of origin. Fourteen studies were cross-sectional, six were cohort studies, and one was a case study. Major risk factors were related to hypertension, diabetes, and age. Prevalence ranged from 2.3% to 53.3% across a variety of countries and patient populations. The wide range in prevalence may have been due to differences in risk factors for the sample populations.
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22
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Ekrikpo UE, Kengne AP, Bello AK, Effa EE, Noubiap JJ, Salako BL, Rayner BL, Remuzzi G, Okpechi IG. Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis. PLoS One 2018; 13:e0195443. [PMID: 29659605 PMCID: PMC5901989 DOI: 10.1371/journal.pone.0195443] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/22/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients. METHODS We searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman-Tukey transformation. RESULT Sixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2-7.7%) with MDRD, 4.8% (95%CI 2.9-7.1%) with CKD-EPI and 12.3% (95%CI 8.4-16.7%) with Cockcroft-Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2-11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9-20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0-3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status. CONCLUSION CKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.
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Affiliation(s)
- Udeme E. Ekrikpo
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Renal Unit, Department of Medicine, University of Uyo, Uyo, Nigeria
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Emmanuel E. Effa
- Renal Unit, Department of Medicine, University of Calabar, Calabar, Nigeria
| | - Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Babatunde L. Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Brian L. Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases Aldo & Cele Daccò, Bergamo, Italy
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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Ekrikpo UE, Kengne AP, Akpan EE, Effa EE, Bello AK, Ekott JU, George C, Salako BL, Okpechi IG. Prevalence and correlates of chronic kidney disease (CKD) among ART-naive HIV patients in the Niger-Delta region of Nigeria. Medicine (Baltimore) 2018; 97:e0380. [PMID: 29668591 PMCID: PMC5916672 DOI: 10.1097/md.0000000000010380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Widespread use of antiretroviral therapy (ART) in human immunodeficiency virus (HIV) patients has led to improved longevity with the attendant increase in noncommunicable disease prevalence including chronic kidney disease (CKD). This study documents the prevalence of CKD in a large HIV population in Southern Nigeria.This is a single center, 15-year analysis in ART-naïve patients. CKD was defined as the occurrence of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m on 2 consecutive occasions 3 to 12 months apart using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The Cochran-Armitage and Cuzick tests were employed to assess for trend across the years for CKD prevalence and CD4 count, respectively. Multivariable logistic regression models were used to identify independent associations with CKD.In all, 1317 patients (62.2% females) with mean age of 34.5 years and median CD4 count of 194 cells/μL were included. CKD prevalence was 13.4% (95%CI 11.6%-15.4%) using the CKD-EPI equation (without the race factor). Multivariable analysis identified increasing age and CD4 count <200 cells/μL as being independently associated with CKD occurrence.This study reports a high prevalence of CKD in ART-naïve HIV-infected patients. Measures to improve diagnosis of kidney disease and ensure early initiation of treatment should be integrated in HIV treatment programmes in this setting.
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Affiliation(s)
- Udeme E. Ekrikpo
- Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa
| | | | | | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - John U. Ekott
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Cape Town, South Africa
| | - Babatunde L. Salako
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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Abstract
OBJECTIVES As data on chronic kidney disease (CKD) incidence among Asian HIV patients has been limited, the present study aimed to estimate the CKD incidence in HIV-infected patients who received standard antiretroviral therapy in Thailand and to compare baseline demographics and clinical characteristics of the patients who developed CKD with those who do not. DESIGN A multicenter, observational prospective cohort of HIV patients with normal kidney functions who received standard antiretroviral therapy. METHODS CKD was diagnosed based on the KDIGO 2012 criteria, using Chronic Kidney Disease Epidemiology Collaboration based estimated glomerular filtration rate with and without urine protein. The cumulative probability of CKD incidence was analyzed using Kaplan-Meier estimation. RESULTS Of 5552 patients, 96 patients with pre-existing CKD and 26 patients with incomplete data were excluded, and 5430 patients were analyzed. Their mean age was 39.87 years, 41.52% were women, and 49.45% were homosexual. They were followed up for 49.41 months on average, with 229 incident cases (4.22%) being identified during 22 035 person-years at risk. Overall CKD incidence rate was 10.39 per 1000 person-years. Average time to CKD was 26.4 months (95% confidence interval: 24.44-28.83). The adjusted relative hazard significantly increased by 8.6% and 10.3% for each additional year of patient age and each additional log10 copies/ml of HIV viral load, respectively. Patients with diabetes mellitus and hypercholesterolemia had significantly higher adjusted relative hazard (3.37 and 1.41; P < 0.001 and P = 0.014), respectively. CONCLUSION CKD incidence among the Thai HIV-infected patients was lower than in white and non-Southeast Asian populations. Diabetes, hypercholesterolemia, age, and HIV viral load were the significant risk factors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01328275.
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Aging in HIV-Infected Subjects: A New Scenario and a New View. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5897298. [PMID: 29430462 PMCID: PMC5753008 DOI: 10.1155/2017/5897298] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022]
Abstract
The prevalence of HIV-infected people aged 50 years or older is increasing rapidly; the proportion will increase from 28% to 73% in 2030. In addition, HIV-infected individuals may be more vulnerable to age-related condition. There is growing evidence that the prevalence of comorbidities and other age-related conditions (geriatric syndromes, functional or neurocognitive/mental problems, polypharmacy, and social difficulties) is higher in the HIV-infected population than in their uninfected counterparts. However, despite the potential impact of this situation on health care, little information exists about the optimal clinical management of older HIV-infected people. Here we examine the age-related conditions in older HIV-infected persons and address clinical management according to author expertise and published literature. Our aim is to advance the debate about the most appropriate management of this population, including less well-studied aspects, such as frequency of screening for psychological/mental and social and functional capabilities.
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Kim EJ, Ahn JY, Kim YJ, Wie SH, Park DW, Song JY, Choi HJ, Chang HH, Choi BY, Choi Y, Choi JY, Han MG, Kang C, Kim JM, Choi JY. The Prevalence and Risk Factors of Renal Insufficiency among Korean HIV-Infected Patients: The Korea HIV/AIDS Cohort Study. Infect Chemother 2017; 49:194-204. [PMID: 29027386 PMCID: PMC5620386 DOI: 10.3947/ic.2017.49.3.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/03/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Renal disease is one of the leading causes of morbidity and mortality among people infected with human immunodeficiency virus (HIV). However, there are very few published studies about renal insufficiency in HIV-infected persons in Asia, especially in South Korea. MATERIALS AND METHODS A cross-sectional study was performed to investigate the prevalence and risk factors of renal insufficiency, defined as <60 mL/min/1.73 m², in subjects in the Korea HIV/AIDS Cohort Study enrolled from 19 institutions between December 2006 and July 2013. Data at entry into the cohort were analyzed. RESULTS Of 454 enrolled subjects, 24 (5.3%) showed renal insufficiency at entry into the cohort. The mean age of patients in the renal insufficiency group was 5.28 years and the majority were male subjects (91.7%). All the patients were receiving antiretroviral agents, mostly protease inhibitor-based regimens (76.4%), for an average of 19 months. In univariate analysis, older age (P = 0.002), diabetes mellitus (DM) (P = 0.0002), unknown route of transmission (P = 0.007), and taking indinavir (P = 0.0022) were associated with renal insufficiency. In multivariable analysis, older age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.03-1.12, P = 0.002], DM [OR 3.03, 95% CI 1.17-7.82, P = 0.022], unknown route of transmission [OR 6.15, 95% CI 1.77-21.33, P = 0.004], and taking indinavir [OR 3.07, 95% CI 1.17-8.05, P = 0.023] were independent risk factors of renal insufficiency. CONCLUSION The prevalence of renal insufficiency in HIV-infected subjects in this study was relatively low, similar to that in other countries. Aging, DM, and taking indinavir were significantly associated with decreased glomerular filtration rate. Furthermore, unknown route of transmission was an independent risk factor, which was interpreted as a reflection of patient compliance. Further studies on the incidence and risk factors of renal insufficiency during HIV infection using follow-up cohort data are necessary.
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Affiliation(s)
- Eun Jin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Jin Young Ahn
- Division of Infectious Diseases, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Youn Jeong Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea
| | - Seong Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University College of Medicine, Suwon, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Division of Infectious Diseases, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyun Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yunsu Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ju Yeon Choi
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Myung Guk Han
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Chun Kang
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - June Myung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Brief Report: Switching to Tenofovir Alafenamide, Coformulated With Elvitegravir, Cobicistat, and Emtricitabine, in HIV-Infected Adults With Renal Impairment: 96-Week Results From a Single-Arm, Multicenter, Open-Label Phase 3 Study. J Acquir Immune Defic Syndr 2017; 74:180-184. [PMID: 27673443 PMCID: PMC5228610 DOI: 10.1097/qai.0000000000001186] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Tenofovir disoproxil fumarate is associated with renal and bone toxicity. In a single-arm, open-label study of 242 virologically suppressed, HIV-infected participants with creatinine clearance 30–69 mL/min who switched to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, participants had stable creatinine clearance, significant and durable improvements in proteinuria, albuminuria, and tubular proteinuria (P < 0.001), and significant increases in hip and spine bone mineral density through 96 weeks (P < 0.001). Eighty-eight percent maintained HIV-1 RNA <50 c/mL at week 96. These longer-term results support the use of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in HIV-infected individuals with mild-moderately impaired renal function.
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Illness Perceptions, Medication Beliefs, and Adherence to Antiretrovirals and Medications for Comorbidities in Adults With HIV Infection and Hypertension or Chronic Kidney Disease. J Acquir Immune Defic Syndr 2017; 73:403-410. [PMID: 27171742 DOI: 10.1097/qai.0000000000001075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mortality in patients with HIV infection is increasingly due to comorbid medical conditions. Research on how adherence to medications for comorbidities relates to antiretroviral (ARV) medication adherence and how interrelations between illness perceptions and medication beliefs about HIV and comorbidities affect medication adherence is needed to inform adherence interventions. METHODS HIV-infected adults with hypertension (HTN) (n = 151) or chronic kidney disease (CKD; n = 41) were recruited from ambulatory practices at an academic medical center. Illness perceptions and medication beliefs about HIV and HTN or CKD were assessed and adherence to one ARV medication and one medication for either HTN or CKD was electronically monitored for 10 weeks. RESULTS Rates of taking, dosing, and timing adherence to ARV medication did not differ from adherence to medication for HTN or CKD, with the exception that patients were more adherent to the timing of their ARV (78%) than to the timing of their antihypertensive (68%; P = 0.01). Patients viewed HIV as better understood, more chronic, having more negative consequences, and eliciting more emotions, compared with HTN. Patients viewed ARVs as more necessary than medication for HTN or CKD. Having a realistic view of the efficacy of ARVs (r = -0.20; P < 0.05) and a high level of perceived HIV understanding (r = 0.21; P < 0.05) correlated with better ARV adherence. CONCLUSIONS Patients with HIV showed similar rates of adherence to ARVs as to medications for comorbidities, despite perceiving HIV as more threatening and ARVs as more important. This can be used in adapting existing interventions for ARV adherence to encompass adherence to medications for comorbid conditions.
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Rossi C, Raboud J, Walmsley S, Cooper C, Antoniou T, Burchell AN, Hull M, Chia J, Hogg RS, Moodie EEM, Klein MB. Hepatitis C co-infection is associated with an increased risk of incident chronic kidney disease in HIV-infected patients initiating combination antiretroviral therapy. BMC Infect Dis 2017; 17:246. [PMID: 28376824 PMCID: PMC5381089 DOI: 10.1186/s12879-017-2350-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/28/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has reduced mortality from AIDS-related illnesses and chronic comorbidities have become prevalent among HIV-infected patients. We examined the association between hepatitis C virus (HCV) co-infection and chronic kidney disease (CKD) among patients initiating modern antiretroviral therapy. METHODS Data were obtained from the Canadian HIV Observational Cohort for individuals initiating cART from 2000 to 2012. Incident CKD was defined as two consecutive serum creatinine-based estimated glomerular filtration (eGFR) measurements <60 mL/min/1.73m2 obtained ≥3 months apart. CKD incidence rates after cART initiation were compared between HCV co-infected and HIV mono-infected patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression. RESULTS We included 2595 HIV-infected patients with eGFR >60 mL/min/1.73m2 at cART initiation, of which 19% were HCV co-infected. One hundred and fifty patients developed CKD during 10,903 person-years of follow-up (PYFU). The CKD incidence rate was higher among co-infected than HIV mono-infected patients (26.0 per 1000 PYFU vs. 10.7 per 1000 PYFU). After adjusting for demographics, virologic parameters and traditional CKD risk factors, HCV co-infection was associated with a significantly shorter time to incident CKD (HR 1.97; 95% CI: 1.33, 2.90). Additional factors associated with incident CKD were female sex, increasing age after 40 years, lower baseline eGFR below 100 mL/min/1.73m2, increasing HIV viral load and cumulative exposure to tenofovir and lopinavir. CONCLUSIONS HCV co-infection was associated with an increased risk of incident CKD among HIV-infected patients initiating cART. HCV-HIV co-infected patients should be monitored for kidney disease and may benefit from available HCV treatments.
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Affiliation(s)
- Carmine Rossi
- Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Sharon Walmsley
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | | | - Tony Antoniou
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jason Chia
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montréal, Canada. .,Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montréal, H4A 3J1, Canada.
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Jotwani V, Scherzer R, Estrella MM, Jacobson LP, Witt MD, Palella F, Ho K, Bennett M, Parikh CR, Ix JH, Shlipak M. Association of HIV infection with biomarkers of kidney injury and fibrosis in the Multicenter AIDS Cohort Study. Antivir Ther 2017; 22:421-429. [PMID: 28054933 PMCID: PMC5498264 DOI: 10.3851/imp3124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is common among HIV-infected individuals but serum creatinine is insensitive for detecting kidney damage at early stages. We hypothesized that HIV infection would be associated with elevations in subclinical markers of kidney injury and fibrosis in a contemporary cohort of men. METHODS In this cross-sectional study, we measured urine levels of interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), pro-collagen type III N-terminal pro-peptide (PIIINP) and albumin-creatinine ratio (ACR) in 813 HIV-infected and 331 uninfected men enrolled in the Multicenter AIDS Cohort Study. RESULTS Median eGFR was 95 ml/min/1.73 m2 among African-Americans (n=376) and 87 ml/min/1.73 m2 among Caucasians (n=768). Among HIV-infected men, the median CD4 lymphocyte count was 572 cells/mm3 and 76% of men had undetectable HIV RNA levels. After multivariable adjustment for traditional CKD risk factors including eGFR, HIV infection was associated with 52% higher urine IL-18 (95% CI, 33%, 73%), 44% higher KIM-1 (27%, 64%), 30% higher PIIINP (15%, 47%) and 84% higher ACR (54%, 120%), with similar effect sizes among African-Americans and Caucasians (P>0.2 for tests of interaction by race). These associations remained statistically significant in analyses that excluded persons with detectable HIV RNA levels and in models that adjusted for cumulative exposure to tenofovir disoproxil fumarate. CONCLUSIONS Compared with uninfected men, HIV-infected men had more extensive glomerular and tubulointerstitial damage, as assessed by urine biomarkers. Future studies should evaluate whether combinations of biomarkers can be used to monitor stages of kidney injury and to predict CKD risk in HIV-infected individuals.
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Affiliation(s)
- Vasantha Jotwani
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
| | - Rebecca Scherzer
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
| | - Michelle M Estrella
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mallory D Witt
- Division of HIV Medicine, Department of Medicine, Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Frank Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Ken Ho
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA
- Program of Applied Translational Research, Yale University, New Haven, CT, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, CA, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael Shlipak
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
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Ascher SB, Scherzer R, Peralta CA, Tien PC, Grunfeld C, Estrella MM, Abraham A, Gustafson DR, Nowicki M, Sharma A, Cohen MH, Butch AW, Young MA, Bennett MR, Shlipak MG. Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women. Hypertension 2016; 69:304-313. [PMID: 27993956 DOI: 10.1161/hypertensionaha.116.08258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/16/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022]
Abstract
Subclinical kidney disease is associated with developing hypertension in the general population, but data are lacking among HIV-infected people. We examined associations of kidney function and injury with incident hypertension in 823 HIV-infected and 267 HIV-uninfected women in the Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-infected and uninfected women in the United States. Baseline kidney biomarkers included estimated glomerular filtration rate using cystatin C, urine albumin-to-creatinine ratio, and 7 urine biomarkers of tubular injury: α-1-microglobulin, interleukin-18, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, liver fatty acid-binding protein, N-acetyl-β-d-glucosaminidase, and α1-acid-glycoprotein. We used multivariable Poisson regression to evaluate associations of kidney biomarkers with incident hypertension, defined as 2 consecutive visits of antihypertensive medication use. During a median follow-up of 9.6 years, 288 HIV-infected women (35%) developed hypertension. Among the HIV-infected women, higher urine albumin-to-creatinine ratio was independently associated with incident hypertension (relative risk =1.13 per urine albumin-to-creatinine ratio doubling, 95% confidence interval, 1.07-1.20), as was lower estimated glomerular filtration rate (relative risk =1.10 per 10 mL/min/1.73 m2 lower estimated glomerular filtration rate; 95% confidence interval, 1.04-1.17). No tubular injury and dysfunction biomarkers were independently associated with incident hypertension in HIV-infected women. In contrast, among the HIV-uninfected women, urine albumin-to-creatinine ratio was not associated with incident hypertension, whereas higher urine interleukin-18, α1-acid-glycoprotein, and N-acetyl-β-d-glucosaminidase levels were significantly associated with incident hypertension. These findings suggest that early glomerular injury and kidney dysfunction may be involved in the pathogenesis of hypertension in HIV-infected people. The associations of tubular markers with hypertension in HIV-uninfected women should be validated in other studies.
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Affiliation(s)
- Simon B Ascher
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Rebecca Scherzer
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Carmen A Peralta
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Phyllis C Tien
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Carl Grunfeld
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Michelle M Estrella
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Alison Abraham
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Deborah R Gustafson
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Marek Nowicki
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Anjali Sharma
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Mardge H Cohen
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Anthony W Butch
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Mary A Young
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Michael R Bennett
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Michael G Shlipak
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.).
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Diana NE, Naicker S. Update on current management of chronic kidney disease in patients with HIV infection. Int J Nephrol Renovasc Dis 2016; 9:223-234. [PMID: 27695357 PMCID: PMC5033612 DOI: 10.2147/ijnrd.s93887] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN). However, the prevalence of end-stage renal disease in HIV-positive individuals has risen, mainly due to increased longevity on cART. There is a disparity in the occurrence of HIVAN among HIV-positive individuals such that there is an 18- to 50-fold increased risk of developing kidney disease among HIV-positive individuals of African descent aged between 20 and 64 years and who have a poorer prognosis compared with their European descent counterparts, suggesting that genetic factors play a vital role. Other risk factors include male sex, low CD4 counts, and high viral load. Improvement in renal function has been observed after initiation of cART in patients with HIV-associated CKD. Treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker is recommended, when clinically indicated in patients with confirmed or suspected HIVAN or clinically significant albuminuria. Other standard management approaches for patients with CKD are recommended. These include addressing other cardiovascular risk factors (appropriate use of statins and aspirin, weight loss, cessation of smoking), avoidance of nephrotoxins, and management of serum bicarbonate and uric acid, anemia, calcium, and phosphate abnormalities. Early diagnosis of kidney disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended.
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Affiliation(s)
- Nina E Diana
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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HIV Infection in the Elderly: Arising Challenges. J Aging Res 2016; 2016:2404857. [PMID: 27595022 PMCID: PMC4993911 DOI: 10.1155/2016/2404857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/14/2016] [Accepted: 06/30/2016] [Indexed: 12/27/2022] Open
Abstract
Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients.
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Bonjoch A, Puig J, Pérez-Alvarez N, Juega J, Echeverría P, Clotet B, Romero R, Bonet J, Negredo E. Impact of protease inhibitors on the evolution of urinary markers: Subanalyses from an observational cross-sectional study. Medicine (Baltimore) 2016; 95:e4507. [PMID: 27512868 PMCID: PMC4985323 DOI: 10.1097/md.0000000000004507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Kidney injury (defined as the presence of albuminuria, proteinuria, glycosuria [without hyperglycemia], hematuria, and/or renal hypophosphatemia) is an emerging problem in human immunodeficiency virus (HIV)-infected patients, although few data are available on the role of protease inhibitors (PIs) in this condition.To determine the time to kidney injury in a cohort of HIV-infected patients receiving a PI-containing regimen.We report the results of a subanalysis of a published cross-sectional study. The subanalysis included only patients receiving PI-containing regimens for more than 6 months (377 of the overall 970 patients). We determined associated factors and constructed receiver operating characteristic curves to estimate time to kidney injury depending on the PI used.The percentage of patients with kidney injury was 27.7% for darunavir, 27.9% for lopinavir, and 30% for atazanavir. Time to kidney injury was as follows: 229 days for atazanavir/ritonavir (area under the curve [AUC], 0.639; sensitivity, 0.89; specificity, 0.41); 332 days for atazanavir/ritonavir plus tenofovir (AUC, 0.603; sensitivity, 0.75; and specificity, 0.29); 318 days for nonboosted atazanavir (AUC, 0.581; sensitivity, 0.89; and specificity, 0.29); 478 days for lopinavir/ritonavir (AUC, 0.566; sensitivity, 0.864; and specificity, 0.44); 1339 days for lopinavir/ritonavir plus tenofovir (AUC, 0.667; sensitivity, 0.86; and specificity, 0.77); 283 days for darunavir/ritonavir (AUC, 0.523; sensitivity, 0.80; and specificity, 0.261); and 286 days for darunavir/ritonavir plus tenofovir (AUC, 0.446; sensitivity, 0.789; and specificity, 0.245). The use of lopinavir/ritonavir without tenofovir was a protective factor (odds ratio = 1.772; 95%CI, 1.070-2.93; P = 0.026).For all PIs, the percentage of patients with kidney injury exceeded 27%, irrespective of tenofovir use. The longest time to kidney injury was recorded with lopinavir/ritonavir. These results demonstrate the need for renal monitoring, including urine samples, in patients receiving a PI-based regimen, even when tenofovir is not used concomitantly.
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Affiliation(s)
- Anna Bonjoch
- Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Puig
- Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Nuria Pérez-Alvarez
- Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
- Statistics and Operations Research Department, Universitat Politècnica de Catalunya, Spain
| | - Javier Juega
- Nefrology department, Hospital Germans Trias i Pujol, Spain
| | - Patricia Echeverría
- Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Bonaventura Clotet
- Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
- IrsiCaixa Foundation, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Ramón Romero
- Nefrology department, Hospital Germans Trias i Pujol, Spain
| | - J. Bonet
- Nefrology department, Hospital Germans Trias i Pujol, Spain
| | - E. Negredo
- Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
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Frequent injection cocaine use increases the risk of renal impairment among hepatitis C and HIV coinfected patients. AIDS 2016; 30:1403-311. [PMID: 26859371 PMCID: PMC4867986 DOI: 10.1097/qad.0000000000001060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Supplemental Digital Content is available in the text Objective: To examine the association between injection cocaine use, hepatitis C virus (HCV) infection, and chronic renal impairment (CRI). Design: Prospective observational cohort study of HIV–HCV coinfected patients. Methods: Data from 1129 participants in the Canadian Co-Infection Cohort with baseline and follow-up serum creatinine measurements between 2003 and 2014 were analyzed. Prevalent and incident cohorts were created to examine the association between self-reported past, current, and cumulative cocaine use and chronic HCV with CRI. CRI was defined as an estimated glomerular filtration rate below 70 ml/min per 1.73 m2. Multivariate logistic regression was used to calculate odds ratios, and discrete-time proportional-hazards models were used to calculate hazard ratios for cocaine use, in the two respective cohorts, adjusted for HCV RNA and important demographic, HIV disease stage, and comorbidity confounders. Results: Eighty-seven participants (8%) had prevalent CRI. Past injection cocaine use was associated with a two-fold greater risk of prevalent CRI [odds ratio 2.03, 95% confidence interval (CI) 0.96, 4.32]. During follow-up, 126 of 1061 participants (12%) developed incident CRI (31 per 1000 person-years). Compared to nonusers, heavy (≥ 3 days/week) and frequent injection cocaine users (≥75% of follow-up time) experienced more rapid progression to CRI (hazard ratio 2.65, 95% CI 1.35, 5.21; and hazard ratio 1.82, 95% CI 1.07, 3.07, respectively). There was no association between chronic HCV and CRI in either cohort. Conclusion: After accounting for HCV RNA, frequent and cumulative injection cocaine abuse was associated with CRI progression and should be taken into consideration when evaluating impaired renal function in HIV–HCV coinfection.
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Abstract
Chronic kidney disease (CKD) is a frequent complication of HIV infection, occurring in 3.5 - 48.5%, and occurs as a complication of HIV infection, other co-morbid disease and infections and as a consequence of therapy of HIV infection and its complications. The classic involvement of the kidney by HIV infection is HIV-associated nephropathy (HIVAN), occurring typically in young adults of African ancestry with advanced HIV disease in association with APOL1 high-risk variants. HIV-immune complex disease is the second most common diagnosis obtained from biopsies of patients with HIV-CKD. CKD is mediated by factors related to the virus, host genetic predisposition and environmental factors. The host response to HIV infection may influence disease phenotype through activation of cytokine pathways. With the introduction of antiretroviral therapy (ART), there has been a decline in the incidence of HIVAN, with an increasing prevalence of focal segmental glomerulosclerosis. Several studies have demonstrated the overall improvement in kidney function when initiating ART for HIV CKD. Progression to end stage kidney disease has been reported to be more likely when high grade proteinuria, severely reduced eGFR, hepatitis B and/C co-infection, diabetes mellitus, extensive glomerulosclerosis, and chronic interstitial fibrosis are present. Improved renal survival is associated with use of renin angiotensin system blockers and viral suppression. Many antiretroviral medications are partially or completely eliminated by the kidney and require dose adjustment in CKD. Certain drug classes, such as the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors, are metabolized by the liver and do not require dose adjustment. HIV-infected patients requiring either hemo- or peritoneal dialysis, who are stable on ART, are achieving survival rates comparable to those of dialysis patients without HIV infection. Kidney transplantation has been performed successfully in HIV-infected patients; graft and patient survival appears to be similar to that of HIV-uninfected recipients. Early detection of kidney disease by implementation of screening on diagnosis of HIV infection and annual screening thereafter will have an impact on the burden of disease, together with access to ART to those who require it. Programs for prevention of HIV infection are essential to prevent this lethal disease.
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Hara M, Yanagisawa N, Ohta A, Momoki K, Tsuchiya K, Nitta K, Ando M. Increased non-HDL-C level linked with a rapid rate of renal function decline in HIV-infected patients. Clin Exp Nephrol 2016; 21:275-282. [PMID: 27194410 DOI: 10.1007/s10157-016-1281-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/11/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The risk of developing CKD is increased in HIV-infected patients; however, the relationship between renal function decline and lipid abnormalities currently remains unclear in these patients. METHODS A retrospective cohort study was conducted on 661 HIV-infected patients, whose estimated glomerular filtration rates (eGFRs) were consecutively measured over 6 years. The rate of declines in eGFR per year was calculated, with decreases being evaluated using a linear mixed effect model. The distribution of decreases in eGFR ≥ 30 % from baseline during the follow-up period was compared across quartiles of non-high-density lipoprotein cholesterol (HDL-C) levels using the Cochran-Armitage test. A multivariate logistic regression model was built to examine the relationship between dyslipidemia and decreases in eGFR. RESULTS The prevalence of CKD increased from 8.5 to 21.2 % during the follow-up. The average of 6 annual eGFR decline rates was 2.01 ± 0.09 ml/min/1.73 m2/year, which was more than 6-fold higher than that of age-matched controls. The distribution of decreases in eGFR significantly increased across the quartiles of non-HDL-C (p value for trend = 0.0359). Non-HDL-C levels greater than the median value of the cohort were identified as a significant risk factor for decreased eGFR [odds ratio (95 % confidence interval), 1.77 (1.07-3.00)]. CONCLUSION Increased non-HDL-C levels are a risk factor for renal function decline in HIV-infected patients.
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Affiliation(s)
- Masaki Hara
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan.,Department IV of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Naoki Yanagisawa
- Division of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan.,Department IV of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Akihito Ohta
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kumiko Momoki
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan.,Department IV of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Ken Tsuchiya
- Department IV of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kosaku Nitta
- Department IV of Internal Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Minoru Ando
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan. .,Department of Medicine, Tokyo Metropolitan Fu-chu Medical and Welfare Center for the Disabled, 2-9-2, Musashidai, Fuchu, Tokyo, 183-8553, Japan.
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Pozniak A, Arribas JR, Gathe J, Gupta SK, Post FA, Bloch M, Avihingsanon A, Crofoot G, Benson P, Lichtenstein K, Ramgopal M, Chetchotisakd P, Custodio JM, Abram ME, Wei X, Cheng A, McCallister S, SenGupta D, Fordyce MW. Switching to Tenofovir Alafenamide, Coformulated With Elvitegravir, Cobicistat, and Emtricitabine, in HIV-Infected Patients With Renal Impairment: 48-Week Results From a Single-Arm, Multicenter, Open-Label Phase 3 Study. J Acquir Immune Defic Syndr 2016; 71:530-7. [PMID: 26627107 PMCID: PMC4804743 DOI: 10.1097/qai.0000000000000908] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/02/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tenofovir alafenamide (TAF) is a novel tenofovir prodrug with improved renal and bone safety compared with TDF-containing regimens. We report the 48 week safety and efficacy of a once-daily single tablet regimen of elvitegravir 150 mg (E), cobicistat 150 mg (C), emtricitabine 200 mg (F), and TAF 10 mg (E/C/F/TAF) in HIV-1-infected patients with mild to moderate renal impairment. METHODS We enrolled virologically suppressed HIV-1-infected subjects with estimated creatinine clearance (CrCl) 30-69 mL/min in a single-arm, open-label study to switch regimens to E/C/F/TAF. The primary endpoint was the change from baseline in glomerular filtration rate estimated using various formulae. This study is registered with ClinicalTrials.gov, number NCT01818596. FINDINGS We enrolled and treated 242 patients with mean age 58 years, 18% Black, 39% hypertension, 14% diabetes. Through week 48, no significant change in estimated CrCl was observed. Two patients (0.8%) discontinued study drug for decreased creatinine clearance, neither had evidence of renal tubulopathy and both had uncontrolled hypertension. Subjects had significant improvements in proteinuria, albuminuria, and tubular proteinuria (P < 0.001 for all). Hip and spine bone mineral density significantly increased from baseline to week 48 (mean percent change +1.47 and +2.29, respectively, P < 0.05). Ninety-two percent (222 patients) maintained HIV-1 RNA <50 copies per milliliter at week 48. INTERPRETATION Switch to E/C/F/TAF was associated with minimal change in GFR. Proteinuria, albuminuria and bone mineral density significantly improved. These data support the efficacy and safety of once daily E/C/F/TAF in HIV+ patients with mild or moderate renal impairment without dose adjustment.
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Affiliation(s)
- Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Jose R. Arribas
- Department of Medicine, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | - Samir K. Gupta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Frank A. Post
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, Australia
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Streinu-Cercel A, Săndulescu O, Ceapraga G, Manolache D, Stoica MA, Preoțescu LL, Streinu-Cercel A. Prevalence of osteo-renal impairment in the Romanian HIV cohort. BMC Infect Dis 2016; 16 Suppl 1:93. [PMID: 27169468 PMCID: PMC4896252 DOI: 10.1186/s12879-016-1397-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 01/20/2023] Open
Abstract
Background The Romanian HIV cohort has certain particularities that render it unique in Europe. We have performed a study to evaluate the prevalence of bone and kidney impairment in this particular group of HIV-infected patients. Methods We performed dual-energy X-ray absorptiometry (DXA) evaluation of the lumbar vertebrae and the femur, as well as laboratory tests including standard serum panels, bone-related markers and urinalysis in patients from the Romanian HIV cohort. Results The study included 72 patients, of which 46 (58.3 %) were males. The median (IQR) age was 38 (18) years and the median (IQR) time from HIV infection diagnosis was 9 (13) years. Most patients (55.6 %) were non-smokers, but a relatively high proportion (37.5 %) was currently smoking. Only a small percentage of patients (20.8 %) did not present any comorbidities, while 40.3 % had one comorbidity, the most frequent being dyslipidemia (present in 25 patients, 38.5 %). Only 6 patients had a medical history suggestive for renal disease and 3 for bone-related abnormalities. The median (IQR) glomerular filtration rate was 97.5 (33.0) mL/min/1.73sqm. We diagnosed 21 patients (29.6 %) with stage 2 chronic kidney disease and one patient (1.4 %) with stage 3 chronic kidney disease. Proteinuria was present in 9 (12.7 %) patients. The estimated glomerular filtration rate was significantly lower in patients with cardiac comorbidities (p = 0.013). Vitamin D was significantly lower in smokers compared with non-smokers, with a mean value of 15 vs. 21 ng/mL and a moderate effect size (Cohen’s d = −0.5) (p = 0.046). Lumbar osteopenia and osteoporosis were diagnosed in 33.3 and 13.7 % of patients, while femoral osteopenia and osteoporosis were diagnosed in 37.3 and 7.8 %, respectively. Lower nadir CD4 cell counts were found in patients with bone-related comorbidities (p = 0.000). Conclusions We identified a relatively high prevalence of chronic kidney disease in the Romanian HIV cohort, and a fairly low prevalence of osteopenia and osteoporosis, compared with other European countries. In this category of patients smoking should be avoided altogether, as it may be an indirect risk factor for kidney disease (associating cardiac comorbidities) and it may impair bone metabolism by altering serum levels of hydroxy-vitamin D.
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Affiliation(s)
- Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Oana Săndulescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. .,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania.
| | - Gabriela Ceapraga
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Daniela Manolache
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Monica Andreea Stoica
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Liliana Lucia Preoțescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Adrian Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
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Anyabolu EN, Chukwuonye II, Arodiwe E, Ijoma CK, Ulasi I. Prevalence and predictors of chronic kidney disease in newly diagnosed human immunodeficiency virus patients in Owerri, Nigeria. Indian J Nephrol 2016; 26:10-5. [PMID: 26937072 PMCID: PMC4753735 DOI: 10.4103/0971-4065.156115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection is a common cause of chronic kidney disease (CKD) in Sub-Saharan Africa. This study aims at identifying the prevalence and predictors of CKD in newly diagnosed HIV patients in Owerri, South East Nigeria. This was a cross-sectional study consisting of 393 newly diagnosed HIV-seropositive subjects and 136 age- and sex-matched seronegative subjects as controls. CKD was defined as 24-hour urine protein (24-HUP) ≥0.3 g and/or glomerular filtration rate (GFR) < 60 ml/min. Subjects were recruited from the HIV clinic and the Medical Outpatient Department of Federal Medical Centre, Owerri. Clinical and anthropometric data were collected. Relevant investigations were performed, including HIV screening and relevant urine and blood investigations. The mean age of the HIV subjects was 38.84 ± 10.65 years. CKD was present in 86 (22.9%) HIV subjects and 11 (8.l %) controls. Low waist circumference (WC), high serum creatinine, high spot urine protein/creatinine ratio (SUPCR), high 24-HUP/creatinine Ratio (24-HUPCR), high 24-HUP/osmolality Ratio (24-HUPOR) predicted CKD in HIV subjects. CKD prevalence is high (22.9%) among newly diagnosed HIV patients in South East Nigeria. The predictors of CKD included WC, serum creatinine, SUPCR, 24-HUPCR, and 24-HUPOR.
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Affiliation(s)
- E N Anyabolu
- Department of Medicine, Division of Nephrology, Federal Medical Centre, Owerri, Nigeria; Department of Medicine, Division of Nephrology, Imo State University Teaching Hospital, Orlu, Nigeria
| | - I I Chukwuonye
- Department of Medicine, Division of Nephrology, Federal Medical Centre, Owerri, Nigeria; Department of Medicine, Division of Nephrology, Federal Medical Centre, Umuahia, Nigeria
| | - E Arodiwe
- Department of Medicine, Division of Nephrology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - C K Ijoma
- Department of Medicine, Division of Nephrology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - I Ulasi
- Department of Medicine, Division of Nephrology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Défaillance rénale chez le patient infecté par le VIH. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ando M, Yanagisawa N. Epidemiology, clinical characteristics, and management of chronic kidney disease in human immunodeficiency virus-infected patients. World J Nephrol 2015; 4:388-95. [PMID: 26167463 PMCID: PMC4491930 DOI: 10.5527/wjn.v4.i3.388] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/10/2014] [Accepted: 04/08/2015] [Indexed: 02/06/2023] Open
Abstract
Antiretroviral therapy has markedly reduced acquired immune deficiency syndrome-related deaths and opportunistic infectious diseases. This has resulted in prolonged survival of individuals infected with the human immunodeficiency virus (HIV). However, this improvement in survival has been accompanied by an increase in the incidence of chronic kidney disease (CKD) and end-stage renal disease. CKD is now epidemic among HIV-infected populations in both Western and Eastern countries. Risk factors associated with CKD in HIV-infected populations include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, a low CD4 cell count, and a high HIV viral load. Clinical experience has shown that HIV-infected individuals often have one or more concurrent risk factors for CKD. The cumulative effect of multiple risk factors on the development of CKD should be noted in this population. Glomerular disease directly related to HIV infection, so-called HIV-associated nephropathy, remains an important cause of CKD among a limited HIV population of African descent, but is less likely to be common among other urban HIV populations. The impact of exposure to nephrotoxic antiretroviral agents on the development of kidney disease is both an old and a new concern. In particular, the association of tenofovir with kidney tubular injury has been an area of great interest. The findings regarding tenofovir's adverse effect on long-term kidney function vary among studies. The early identification and treatment of CKD is recommended for reducing the burden of patients requiring dialysis in HIV-infected populations. Periodic monitoring of urinary concentrations of albumin, protein, and tubular injury markers such as low-molecular-weight proteins may be useful for the early diagnosis of patients at risk for incident CKD. This review focuses on recent epidemiology, clinical characteristics, and management of CKD in a contemporary HIV-infected population.
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Borkum M, Wearne N, Alfred A, Dave JA, Levitt NS, Rayner B. Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy. Cardiovasc J Afr 2015; 25:153-7. [PMID: 25192297 PMCID: PMC4170173 DOI: 10.5830/cvja-2014-029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 05/03/2014] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) are associated with renal disease and increased cardiovascular risk. The relationship between HIV and ambulatory blood pressure (ABP) non-dipping status, a risk factor for cardiovascular events and target-organ damage, has never been assessed in South Africa. Study objectives were to establish the prevalence of chronic kidney disease, and assess the ABP profile in asymptomatic HIV-positive clinic out-patients. METHODS This was a prospective cohort study. Office blood pressure (BP), urinary microalbumin-creatinine ratio, urine dipsticks, serum creatinine and estimated glomerular filtration rate (eGFR) were measured at baseline and six months after ART initiation. A subset of HIV-positive subjects and an HIV-negative control group underwent 24-hour ABP monitoring. RESULTS No patient had an eGFR < 60 ml/min, three patients (4.7%) had microalbuminuria and one had macroalbuminuria. Mean office systolic BP was 111 ± 14 mmHg at baseline and increased by 5 mmHg to 116 ± 14 mmHg (p = 0.05) at six months. This increase was not confirmed by ABP monitoring. In the HIV-positive and -negative patients, the prevalences of non-dipping were 80 and 52.9%, respectively (p = 0.05, odds ratio = 3.56, 95% CI: 0.96-13.13). No relationship between dipping status and ART usage was found. CONCLUSION The prevalence of chronic kidney disease (CKD) was lower than anticipated. HIV infection was associated with an ambulatory non-dipping status, which suggests an underlying dysregulation of the cardiovascular system. In the short term, ART does not seem to improve loss of circadian rhythm.
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Affiliation(s)
- Megan Borkum
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Nicola Wearne
- Department of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Athlet Alfred
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Joel A Dave
- Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
| | - Brian Rayner
- Department of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
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Abstract
BACKGROUND The outcome of kidney transplantation in human immunodeficiency virus (HIV)–positive patients who receive organs from HIV-negative donors has been reported to be similar to the outcome in HIV-negative recipients. We report the outcomes at 3 to 5 years in HIV-positive patients who received kidneys from HIV-positive deceased donors. METHODS We conducted a prospective, nonrandomized study of kidney transplantation in HIV-infected patients who had a CD4 T-cell count of 200 per cubic millimeter or higher and an undetectable plasma HIV RNA level. All the patients were receiving antiretroviral therapy (ART). The patients received kidneys from deceased donors who tested positive for HIV with the use of fourth-generation enzyme-linked immunosorbent assay at the time of referral. All the donors either had received no ART previously or had received only first-line ART. RESULTS From September 2008 through February 2014, a total of 27 HIV-positive patients underwent kidney transplantation. Survivors were followed for a median of 2.4 years. The rate of survival among the patients was 84% at 1 year, 84% at 3 years, and 74% at 5 years. The corresponding rates of graft survival were 93%, 84%, and 84%. (If a patient died with a functioning graft, the calculation was performed as if the graft had survived.) Rejection rates were 8% at 1 year and 22% at 3 years. HIV infection remained well controlled, with undetectable virus in blood after the transplantation. CONCLUSIONS Kidney transplantation from an HIV-positive donor appears to be an additional treatment option for HIV-infected patients requiring renal-replacement therapy. (Funded by Sanofi South Africa and the Roche Organ Transplantation Research Foundation.)
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Bandera A, Gori A, Sabbatini F, Madeddu G, Bonora S, Libertone R, Mastroianni C, Bonfanti P, d'Arminio Monforte A, Cozzi-Lepri A, Icona Foundation Study Group. Evaluation of the Prognostic Value of Impaired Renal Function on Clinical Progression in a Large Cohort of HIV-Infected People Seen for Care in Italy. PLoS One 2015; 10:e0124252. [PMID: 25933346 PMCID: PMC4416769 DOI: 10.1371/journal.pone.0124252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/12/2015] [Indexed: 11/18/2022] Open
Abstract
Whilst renal dysfunction, especially mild impairment (60<eGFR<90 ml/min), has been often described in HIV-infected population, its potential contribution to HIV evolution and risk of cerebro-cardiovascular disease (CCVD) has not been clarified. Data from HIV-1 infected patients enrolled in the Italian Cohort of Antiretroviral-Naïve (Icona) Foundation Study collected between January 2000 and February 2014 with at least two creatinine values available. eGFR (CKD-epi) and renal dysfunction defined using a priori cut-offs of 60 (severely impaired) and 90 ml/min/1.73m2 (mildly impaired). Characteristics of patients were described after stratification in these groups and compared using chi-square test (categorical variables) or Kruskal Wallis test comparing median values. Follow-up accrued from baseline up to the date of the CCVD or AIDS related events or death or last available visit. Kaplan Meier curves were used to estimate the cumulative probability of occurrence of the events over time. Adjusted analysis was performed using a proportional hazards Cox regression model. We included 7,385 patients, observed for a median follow-up of 43 months (inter-quartile range [IQR]: 21-93 months). Over this time, 130 cerebro-cardiovascular events (including 11 deaths due to CCVD) and 311 AIDS-related events (including 45 deaths) were observed. The rate of CCVD events among patients with eGFR >90, 60-89, <60 ml/min, was 2.91 (95% CI 2.30-3.67), 4.63 (95% CI 3.51-6.11) and 11.9 (95% CI 6.19-22.85) per 1,000 PYFU respectively, with an unadjusted hazard ratio (HR) of 4.14 (95%CI 2.07-8.29) for patients with eGFR <60 ml/min and 1.58 (95%CI 1.10-2.27) for eGFR 60-89 compared to those with eGFR ≥90. Of note, these estimates are adjusted for traditional cardio-vascular risk factors (e.g. smoking, diabetes, hypertension, dyslipidemia). Incidence of AIDS-related events was 9.51 (95%CI 8.35-10.83), 6.04 (95%CI 4.74-7.71) and 25.0 (95%CI 15.96-39.22) per 1,000 PYFU, among patients with eGFR >90, 60-89, <60 ml/min, respectively, with an unadjusted HR of 2.49 (95%CI 1.56-3.97) for patients with eGFR <60 ml/min and 0.68 (95%CI 0.52-0.90) for eGFR 60-89. The risk of AIDS events was significantly lower in mild renal dysfunction group even after adjustment for HIV-related characteristics. Our data confirm that impaired renal function is an important risk marker for CCVD events in the HIV-population; importantly, even those with mild renal impairment (90<eGFR<60) seem to be at increased risk of cerebro-cardiovascular morbidity and mortality.
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Affiliation(s)
- Alessandra Bandera
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- * E-mail:
| | - Andrea Gori
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Francesca Sabbatini
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giordano Madeddu
- Department of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Stefano Bonora
- Department of Infectious Diseases of the University of Torino, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Claudio Mastroianni
- Department of Infectious and Tropical Diseases, Sapienza University, Polo Pontino, Latina, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, Alessandro Manzoni Hospital, Lecco, Italy
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Abgrall S, Rachas A, Tourret J, Isnard-Bagnis C, Billaud E, Tattevin P, Costagliola D, Guiguet M, Durieux P. A multifaceted intervention designed to improve medical management of moderate to advanced chronic kidney disease in HIV-infected patients: a cluster randomized trial. Clin Infect Dis 2015; 61:375-84. [PMID: 25904366 DOI: 10.1093/cid/civ310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/04/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. METHODS To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to either simple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infected patients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. RESULTS Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. CONCLUSIONS Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. CLINICAL TRIALS REGISTRATION CCTIRS 10.150 and CNIL DR-2010-379.
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Affiliation(s)
- Sophie Abgrall
- Sorbonne Universités, UPMC Université Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris AP-HP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart Paris-Sud 11 University, Le Kremlin-Bicêtre
| | - Antoine Rachas
- Paris Descartes University, Hôpital Européen Georges Pompidou INSERM UMRS 872 eq22
| | - Jérome Tourret
- Urology, Nephrology and Transplantation Department, Pitie-Salpetriere Hospital UPMC Paris Université 06
| | - Corinne Isnard-Bagnis
- Urology, Nephrology and Transplantation Department, Pitie-Salpetriere Hospital UPMC Paris Université 06 Chaire de recherche en éducation thérapeutique CNAM-EHESS, Paris
| | - Eric Billaud
- Hôtel-Dieu Universitary Hospital, Infectious Diseases Unit, Nantes
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Université Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris
| | - Marguerite Guiguet
- Sorbonne Universités, UPMC Université Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris
| | - Pierre Durieux
- Paris Descartes University, Hôpital Européen Georges Pompidou INSERM UMRS 872 eq22
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Prakash J, Gupta T, Prakash S, Rathore SS, Usha, Sunder S. Acute kidney injury in patients with human immunodeficiency virus infection. Indian J Nephrol 2015; 25:86-90. [PMID: 25838645 PMCID: PMC4379631 DOI: 10.4103/0971-4065.138696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is an important cause of hospitalization and morbidity in human immunodeficiency virus (HIV)-positive patients. However, the data on AKI in such patients is limited. The aim of the present study was to analyze the incidence, causes and outcome of AKI in HIV-positive patients from our antiretroviral therapy centre. All HIV-positive patients were evaluated for evidence of clinical AKI. AKI was noted in 138/3540 (3.9%) patients. Of 138 AKI patients, 96 (69.6%) had acquired immuno deficiency syndrome and 42 (30.4%) were HIV seropositive. Majority of AKI patients belonged to AKI network (AKIN) Stage II (42%) or III (48.5%) at presentation. Prerenal, intrinsic and postrenal AKI were noted in 53.6%, 44.2% and 2.2% of cases, respectively. Hypovolemia (44.2%) and sepsis (14.5%) contributed to AKI in vast majority of cases. AKI was multifactorial (volume depletion, sepsis and drugs) in 39% of patients. Acute tubular necrosis (ATN) was the most common intrinsic lesion. Acute interstitial nephritis and diffuse endocapillary proliferative glomerulonephritis were noted in five and two cases, respectively. In-hospital mortality was 24.64%. Lower CD4 count, decreased serum albumin level and Stage 4 WHO disease were associated with higher mortality. At 3 months or more follow-up complete recovery of renal function, chronic kidney disease Stage 3-5 and progression to end stage renal disease were noted in 58.69%, 14.5% and 2.2% of cases, respectively. Thus, prerenal factors and ischemic ATN were the most common cause of AKI in HIV-infected patients. Recovery of renal function was seen in 59% of cases, but AKI had high in-hospital mortality.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - T Gupta
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - S Prakash
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - S S Rathore
- Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - Usha
- Department of Pathology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - S Sunder
- Department of Medicine, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
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Andrade-Fuentes K, Mata-Marín JA, López-De León JI, Manjarrez-Téllez B, Ramírez JLS, Gaytan-Martínez J. Proximal renal tubular dysfunction related to antiretroviral therapy among HIV-infected patients in an HIV clinic in Mexico. AIDS Patient Care STDS 2015; 29:181-5. [PMID: 25101526 DOI: 10.1089/apc.2014.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Proximal renal tubular dysfunction (PRTD) of varying severity has been associated with antiretroviral toxicity, especially related to the use of tenofovir (TDF). The aim of this study was to investigate whether HIV-infected patients who use a tenofovir-based regimen are at increased risk of tubular dysfunction. We conducted an observational, comparative, longitudinal, prospective study. Estimated glomerular filtration rate (eGFR) and markers of tubular damage to assess tubular dysfunction (fractional excretion of phosphate and uric acid, glycosuria, and proteinuria) were measured at baseline and at weeks 12 and 24. Of 111 participants, PRTD was found in 6.3% at week 12 and 9% at week 24, with no statistically significant difference between those on an abacavir (ABC)-containing regimen or a TDF-containing regimen. We also found an increase in triglycerides associated with the ABC-containing regimen compared with the TDF group. The use of an ABC- or TDF-containing regimen was independently associated with tubular dysfunction, but we found no significant differences between these groups, except when TDF was combined with a protease inhibitor. A better and more complete assessment of renal function is needed, because the presence of tubular dysfunction and proteinuria without impairment of eGFR may affect the renal safety of HIV-infected patients.
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Affiliation(s)
- Karen Andrade-Fuentes
- Department of Nephrology, Hospital de Infectología “La Raza”, National Medical Center, IMSS, Mexico City, Mexico
| | - José A. Mata-Marín
- Department of Infectious Diseases, Hospital de Infectología “La Raza”, National Medical Center, IMSS, Mexico City, Mexico
| | - José I. López-De León
- Department of Nephrology, Hospital de Infectología “La Raza”, National Medical Center, IMSS, Mexico City, Mexico
| | - Bulmaro Manjarrez-Téllez
- Department of Infectious Diseases, Hospital de Infectología “La Raza”, National Medical Center, IMSS, Mexico City, Mexico
| | - Jorge L. Sandoval Ramírez
- Department of Infectious Diseases, Hospital de Infectología “La Raza”, National Medical Center, IMSS, Mexico City, Mexico
| | - Jesús Gaytan-Martínez
- Department of Infectious Diseases, Hospital de Infectología “La Raza”, National Medical Center, IMSS, Mexico City, Mexico
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Muller E, Barday Z, Mendelson M, Kahn D. HIV-positive-to-HIV-positive kidney transplantation--results at 3 to 5 years. N Engl J Med 2015; 372:613-20. [PMID: 25671253 PMCID: PMC5090019 DOI: 10.1056/nejmoa1408896] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The outcome of kidney transplantation in human immunodeficiency virus (HIV)-positive patients who receive organs from HIV-negative donors has been reported to be similar to the outcome in HIV-negative recipients. We report the outcomes at 3 to 5 years in HIV-positive patients who received kidneys from HIV-positive deceased donors. METHODS We conducted a prospective, nonrandomized study of kidney transplantation in HIV-infected patients who had a CD4 T-cell count of 200 per cubic millimeter or higher and an undetectable plasma HIV RNA level. All the patients were receiving antiretroviral therapy (ART). The patients received kidneys from deceased donors who tested positive for HIV with the use of fourth-generation enzyme-linked immunosorbent assay at the time of referral. All the donors either had received no ART previously or had received only first-line ART. RESULTS From September 2008 through February 2014, a total of 27 HIV-positive patients underwent kidney transplantation. Survivors were followed for a median of 2.4 years. The rate of survival among the patients was 84% at 1 year, 84% at 3 years, and 74% at 5 years. The corresponding rates of graft survival were 93%, 84%, and 84%. (If a patient died with a functioning graft, the calculation was performed as if the graft had survived.) Rejection rates were 8% at 1 year and 22% at 3 years. HIV infection remained well controlled, with undetectable virus in blood after the transplantation. CONCLUSIONS Kidney transplantation from an HIV-positive donor appears to be an additional treatment option for HIV-infected patients requiring renal-replacement therapy. (Funded by Sanofi South Africa and the Roche Organ Transplantation Research Foundation.).
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Affiliation(s)
- Elmi Muller
- From the Transplant Unit, Department of Surgery (E.M.), Division of Nephrology, Department of Medicine (Z.B.), Division of Infectious Diseases and HIV Medicine, Department of Medicine (M.M.), and the Department of Surgery (D.K.), University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Kamkuemah M, Kaplan R, Bekker LG, Little F, Myer L. Renal impairment in HIV-infected patients initiating tenofovir-containing antiretroviral therapy regimens in a Primary Healthcare Setting in South Africa. Trop Med Int Health 2014; 20:518-26. [PMID: 25442109 DOI: 10.1111/tmi.12446] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Long-term use of tenofovir disoproxil fumarate is associated with declines in glomerular function and chronic kidney disease in HIV-infected patients. We aimed to assess the prevalence and incidence of renal impairment in a primary care setting in sub-Saharan Africa. METHODS We analysed data from 1092 HIV-infected patients initiating tenofovir at a primary care clinic in Cape Town, South Africa. Renal function was assessed for the first 12 months on ART by estimating glomerular filtration rate (eGFR) calculated using the Cockroft-Gault equation categorised into normal, mild, moderate and severe reduction in renal function based on values >90, 60-89, 30-59 and <30 ml/min/1.73 m(2) , respectively. Associations were assessed using logistic regression, and average GFR trajectory over time was modelled using linear mixed-effects models. RESULTS The cohort consisted of 62% women; median age was 34 years (IQR 29; 41 years). The majority had normal renal function pre-ART (79%), 19% had mildly reduced GFR, and 2% had moderate renal impairment. Older age, more advanced WHO stage and anaemia were independently associated with prevalent renal impairment. On average, estimated glomerular function improved over the first year on tenofovir [1.10 ml/min/1.73 m(2) average increase over 12 months (95% CI: 0.80; 1.40)]. Male gender, anaemia and immunosuppression (WHO Stage III/IV and CD4 cell counts <100 cells/mm(3) ) were associated with lower average eGFR levels over time. Overall, 3% developed eGFR <50 ml/min/1.73 m(2) during this period. Serum creatinine tests conducted before 4 months on ART had low predictive value for predicting change in eGFR after a year on ART. CONCLUSION Generally, renal function improved in HIV-infected adults initiating ART in this primary healthcare setting during the first year on ART. While monitoring of renal function is recommended in the first 4 months on ART, renal impairment appears uncommon during the first 12 months of tenofovir-containing ART in primary care populations.
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Affiliation(s)
- Monika Kamkuemah
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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