The impact of hepatitis C virus coinfection on HIV-related kidney disease: a systematic review and meta-analysis

Abstract

In the era of antiretroviral therapy, non-AIDS complications such as kidney disease are important contributors to morbidity and mortality. Objective To estimate the impact of hepatitis C co-infection on the risk of kidney disease in HIV patients. Design/ Methods Two investigators identified English-language citations in MEDLINE and Web of Science from 1989 through July 1, 2007. References of selected articles were reviewed. Observational studies and clinical trials of HIV-related kidney disease and antiretroviral nephrotoxicity were eligible if they included at least 50 participants and reported hepatitis C status. Data on study characteristics, population, and kidney disease outcomes were abstracted by two independent reviewers. Results After screening 2,516 articles, twenty-seven studies were eligible and 24 authors confirmed or provided data. Separate meta-analyses were performed for chronic kidney disease outcomes (n=10), proteinuria (n=4), acute renal failure (n=2), and indinavir toxicity (n=5). The pooled incidence of chronic kidney disease was higher in patients with hepatitis C co-infection (6.2% versus 4.0%; RR 1.49, 95% CI 1.08–2.06). In meta-regression, prevalence of black race and the proportion of patients with documented hepatitis C status were independently associated with the risk of chronic kidney disease. The relative risk associated with hepatitis C co-infection was significantly increased for proteinuria (1.15; 95% CI 1.02–1.30) and acute renal failure (1.64; 95% CI 1.21–2.23), with no significant statistical heterogeneity. The relative risk of indinavir toxicity was 1.59 (95% CI 0.99–2.54) with Hepatitis C co-infection. Conclusions Hepatitis C co-infection is associated with a significant increase in the risk of HIV-related kidney disease.

HIV and Proteinuria in an Injection Drug User Population

“…In a study of 202 Hispanic HIV-infected and -uninfected drug users, the prevalence of proteinuria was only 10.9% (14). A meta-analysis of HIV/ HCV co-infected populations, to which our HIV-infected participants should be similar, suggested a pooled estimate of CKD prevalence of 28% (15), which is 21% lower than the estimate among our HIV/HCV co-infected participants. The heavier burden of proteinuria in our population may collectively reflect the predominance of African-American participants in our study and the high prevalence of HIV, HCV, and HIV/HCV co-infection.…”

“…Although we did not observe an association between African-American race and proteinuria, this may reflect the small sample size of Caucasians, and the overall high prevalence of proteinuria in this cohort may at least in part reflect the predominance of African Americans. In previous studies, which drew from this and similar populations, strong associations were observed between African-American race and development of ESRD, and survival rates after dialysis initiation were poor (15,27). Early diagnosis and care for CKD may help to prevent more serious kidney damage, eventual kidney failure, and the need for dialysis.…”

Hepatitis C Virus Infection and Kidney Disease

“…Thirty-eight observational studies were considered eligible but were excluded because outcomes from HCV-HIV co-infected participants (n=32) (15), patients with diabetes (n=2) (16,17), HCV-infected patients (n=1) (18), and chronic GN patients only (n=1) (19) were reported. Two studies did not account for important potential confounders in their analyses (20,21).…”

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

“…However, the authors commented that few of the studies provided a clear definition of HCV coinfection, and only one required HCV RNA testing for diagnosis. 8 Thus, additional investigation is needed to understand the mechanisms underlying the association between HIV/HCV coinfection and renal disease.…”