The incidence of AIDS-defining events in patients with advanced HIV infection at Frankfurt University Hospital has declined by more than 70% from 1992 to 1996.

Changes in surrogate markers suggest that treatment provided benefit in spite of virological failure and resistant virus. Although patients with a shift to wildtype virus responded better in the short term to treatment re-initiation, the long-term effects are not known and the risk of immune deterioration needs to be carefully considered.

These results strongly support a direct causal relationship between HIV replication and CD4 lymphocyte count depletion. The rise in those with > 3 log suppression provides the best available indicator of the potential for natural CD4 regeneration in HIV-infected patients. However, since still greater CD4 count rises may be seen with more suppressive regimens, it may not be possible to study the intrinsic CD4 regenerative capacity until such regimens are available.

ObjectivesRenal disease is a common and serious complication in HIV-infected patients. MethodsA retrospective cohort analysis for the period 1989-2010 was carried out to determine the prevalence, incidence and risk factors for end-stage renal disease (ESRD). ESRD was defined as initiation of renal replacement therapy. Three time periods were defined: 1989-1996 [pre-highly active antiretroviral therapy (HAART)], 1997 (early HAART) and 2004. ResultsData for 9198 patients [78.2% male; 88.9% Caucasian; cumulative observation time 68 084 patient-years (PY)] were analysed. ESRD was newly diagnosed in 35 patients (0.38%). Risk factors for ESRD were Black ethnicity [relative risk (RR) 5.1; 95% confidence interval (CI) 2.3-10.3; P < 0.0001], injecting drug use (IDU) (RR 2.3; 95% CI 1.1-4.6; P = 0.02) and hepatitis C virus (HCV) coinfection (RR 2.2; 95% CI 1.1-4.2; P = 0.03). The incidence of ESRD decreased in Black patients over the three time periods [from 788.8 to 130.5 and 164.1 per 100 000 PY of follow-up (PYFU), respectively], but increased in Caucasian patients (from 29.9 to 41.0 and 43.4 per 100 000 PYFU, respectively). The prevalence of ESRD increased over time and reached 1.9 per 1000 patients in 2010. Mortality for patients with ESRD decreased nonsignificantly from period 1 to 2 (RR 0.72; P = 0.52), but significantly from period 1 to 3 (RR 0.24; P = 0.006), whereas for patients without ESRD mortality decreased significantly for all comparisons. ESRD was associated with a high overall mortality (RR 9.9; 95% CI 6.3-14.5; P < 0.0001). ConclusionAs a result of longer survival, the prevalence of ESRD is increasing but remains associated with a high mortality. The incidence of ESRD declined in Black but not in Caucasian patients. IDU and HCV were identified as additional risk factors for the development of ESRD.Keywords: chronic kidney disease, haemodialysis, HIV-associated nephropathy, renal failure, renal replacement therapy Accepted 18 July 2012 IntroductionThe prevention and treatment of cardiovascular, liver and kidney diseases have increasingly been the focus of attention in attempts to reduce the morbidity and mortality of HIV-infected individuals [1]. In the USA, HIV-associated ESRD has become epidemic among Black patients [11,12]. Black individuals are more prone to kidney disease than any other ethnic group in the general [13,14] and HIV-infected populations, possibly as a consequence of predisposing genetic polymorphisms [15]. The risk of ESRD in Black HIV-infected individuals has been reported to be three-to six-fold higher than in Caucasian HIV-infected patients [7,16,17], reflecting the susceptibility of Black patients to develop HIVAN. The introduction of highly active antiretroviral therapy (HAART) has reduced the incidence of HIVAN and ESRD among Black patients [18][19][20], but the prevalence of ESRD is projected to further increase [11,12]. Earlier studies, mainly from the USA, concluded that, almost exclusively in Black patients, HIVAN is one of the major causes of ESRD [6,21,22], but histologica...

The combination of lopinavir/ritonavir and saquinavir without RTIs is a potential option as salvage therapy for patients experiencing therapy failure due to RTI resistance or toxicity. This regimen may not be suitable for patients with very low baseline CD4 cell counts, very broad antiretroviral therapy experience or extensive PI-resistance mutations.