Hepatitis B and C Co-Infection Are Independent Predictors of Progressive Kidney Disease in HIV-Positive, Antiretroviral-Treated Adults

Abstract

Chronic kidney disease (CKD) is an important cause of morbidity and mortality in HIV-positive individuals. Hepatitis C (HCV) co-infection has been associated with increased risk of CKD, but prior studies lack information on potential mechanisms. We evaluated the association between HCV or hepatitis B (HBV) co-infection and progressive CKD among 3,441 antiretroviral-treated clinical trial participants. Progressive CKD was defined as the composite of end-stage renal disease, renal death, or significant glomerular filtration rate (eGFR) decline (25% decline to eGFR <60 mL/min/1.73 m2 or 25% decline with a baseline <60). Generalized Estimating Equations were used to model the odds of progressive CKD. At baseline, 13.8% and 3.3% of participants were co-infected with HCV and HBV, respectively. Median eGFR was 111, and 3.7% developed progressive CKD. After adjustment, the odds of progressive CKD were increased in participants with HCV (OR 1.72, 95% CI 1.07–2.76) or HBV (OR 2.26, 95% CI 1.15–4.44). Participants with undetectable or low HCV-RNA had similar odds of progressive CKD as HCV seronegative participants, while participants with HCV-RNA >800,000 IU/ml had increased odds (OR 3.07; 95% CI 1.60–5.90). Interleukin-6, hyaluronic acid, and the FIB-4 hepatic fibrosis index were higher among participants who developed progressive CKD, but were no longer associated with progressive CKD after adjustment. Future studies should validate the relationship between HCV viremia and CKD.Trial RegistrationClinicalTrials.gov NCT00027352; NCT00004978

Increased incidence of antiretroviral drug discontinuation among patients with viremic hepatitis C virus coinfection and high hyaluronic acid, a marker of liver fibrosis

“…The common combination of efavirenz and tenofovir could explain some of the effects seen for tenofovir, as efavirenz was strongly associated with drug discontinuation. Alternatively, viremic HCV infection has been associated with increased risk of chronic kidney disease [37,38], which due to the primary renal excretion of tenofovir [3] and its link with chronic renal impairment [39] would often lead to discontinuation.…”

Stability of hepatitis C virus (HCV) RNA levels among interferon‐naïve HIV/HCV‐coinfected individuals treated with combination antiretroviral therapy

“…More weight will often be given to other factors, such as level of fibrosis, HCV genotype, IL-28B gene variant and a patient's readiness for treatment [1,22]. However, with recent studies suggesting a link between high HCV viral loads (> 500 000 IU/ml) and progression to chronic kidney disease [23,24], increasing HCV RNA could become more clinically important in the future.HIV viral load when fitted on a log 10 continuous scale was found to have a significant relationship with HCV RNA, which further supports our finding that treatment with cART can help to control HCV RNA. These findings, building on evidence from a similar study [4], have potential implications for the treatment of persons with HCV/ HIV coinfection.…”

Factors associated with iohexol-based glomerular filtration rate slope over 36 months in HIV-negative and HIV-positive individuals

“…HCV has been associated with CKD and ESRD in other studies [13]. However, it is difficult to disentangle HCV infection effects from associated socioeconomic and behavioral factors, including drug use [14–17]. In our study, we measured cocaine use, both by self-report and by urine drug screen.…”