Prevalence and Factors Associated with Renal Dysfunction Among HIV-Infected Patients

Abstract

Renal dysfunction is an increasingly recognized non-AIDS-defining comorbidity among HIV-infected persons. The role of HIV-related factors in renal dysfunction remains unclear. We performed a cross-sectional study at two military clinics with open access to care to determine the impact of HIV factors, including antiretroviral therapy, on renal function. Renal dysfunction was defined as a glomerular filtration rate (GFR) < 60 mL/min/ 1.73 m 2 . We evaluated 717 HIV patients with a median age of 41 years; 92% were male, 49% Caucasian, and 38% African American; median CD4 count was 515 cells/mm 3 and 73% were receiving highly active antiretroviral therapy (HAART). Twenty-two patients (3%) had renal dysfunction. Factors associated with renal dysfunction in the multivariate logistic analyses included older age (odds ratio [OR] 2.0 per 10 year increase, p ¼ 0.006), lower CD4 nadir (OR 0.6 per 100 cell change, p ¼ 0.02), and duration of tenofovir use (OR 1.5 per year use, p ¼ 0.01). Among persons initiating tenofovir (n ¼ 241), 50% experienced a reduction in GFR (median À10.5 mL/min/ 1.73 m 2 , 95% CI, À8.9 to À13.3) within 2 years. Among tenofovir users, factors associated with a reduction in GFR included female gender ( p < 0.001), African American ethnicity ( p ¼ 0.003), and lower CD4 nadir ( p ¼ 0.002). In summary, renal dysfunction was relatively uncommon among our HIV-infected patients, perhaps due to their young age, lack of comorbidities, or as a result of our definition that did not include proteinuria. Renal dysfunction was associated with duration of tenofovir use. Factors associated with renal loss among tenofovir users included female gender, African American ethnicity, and CD4 nadir <200 cells/mm 3 . Consideration for more frequent monitoring of kidney function among these select HIV patients may be warranted.

Hypertension is Common among HIV-Infected Persons, But Not Associated with HAART

“…Obesity was noted in 18% of the study population, while diabetes mellitus was present in 8%. The median duration of HIV infection was 11.5 years (IQR: [6][7][8][9][10][11][12][13][14][15][16][17]. The median CD4 count was 510 cells/mm 3 (IQR: 368-704), and 78% had a current CD4 count >350 cells/mm 3 .…”

“…In addition, the final model was adjusted for demographic data and clinical site (NMCSD and NNMC) based on prior data showing site differences. 16 Given that ARV medication use was the primary variable of interest in our study, we also evaluated its association with hypertension in the final model. All P values were 2-sided and a value of <.05 was considered statistically significant.…”

Incidence and Predictors of Acute Kidney Injury in an Urban Cohort of Subjects with HIV and Hepatitis C Virus Coinfection

“…Indinavir-associated renal dysfunction is well documented and there is also growing evidence of an association between tenofovir use and loss of renal function. [22][23][24][25][26][27] In a recent meta-analysis that included 17 studies to assess the renal safety of tenofovir in HIV-infected patients, a statistically significant greater loss in creatinine clearance was observed among tenofovir recipients compared to control subjects, as well as a significantly greater risk of acute renal failure among tenofovir recipients. 22 Of subjects on ARVs at the time of AKI, 45% were receiving indinavir or tenofovir-containing regimens, reflecting evolving drug availability and prescribing practices during the study period.…”

Obesity Is Associated with Race/Sex Disparities in Diabetes and Hypertension Prevalence, But Not Cardiovascular Disease, Among HIV-Infected Adults

“…[1][2][3][4][5][6] People living with HIV (PLWH) in the United States are now diagnosed with a number of age-related chronic conditions including cardiovascular disease, renal disease, and diabetes at rates at least as great as and often greater than those of HIV-uninfected populations. [7][8][9][10][11][12] A striking increase in obesity [body mass index (BMI) ‡30 kg/m is known regarding the associations of race, sex, and obesity with CMD risk. Therefore, in the present study we compared the prevalence of CMD and obesity by race/sex among a crosssectional cohort of PLWH, and evaluated whether obesity impacts the associations between race/sex and CMD.…”