Viremia copy-years and risk of estimated glomerular filtration rate reduction in adults living with perinatal HIV infection

Abstract

Among people with perinatal HIV infection (PHIV), non-communicable diseases, such as chronic kidney disease, are increasing. Both HIV replication and antiretroviral therapy are recognised causes of renal impairment. Objective of the study is to describe the impact of viremia copy-years (VCY) and antiretroviral therapy on trend of estimated glomerular filtration rate (eGFR) in a cohort of adults with perinatal HIV infection. We conducted a multicentre observational study in sixty adults living with PHIV across a 9-year period, from January 2010 to December 2018. The mean values of eGFR were analysed at the first (T0) and last year of observation (T1). VCY was defined as the area under HIV-RNA curve during the study period. We analysed data according to antiretroviral therapy: tenofovir disoproxil (TDF), non-nucleoside reverse transcriptase inhibitors (NNRTI), boosted protease inhibitors (PI/b), integrase inhibitors (INI). We observed a mean overall eGFR reduction from 126.6 mL/min (95%CI: 119.6–133.5) to 105.0 mL/min (95%CI: 99.55–110.6) ( p <0.001). Older age, higher baseline eGFR, higher VCY and longer exposure to INI treatment were associated with eGFR reduction at univariate analysis. In the multivariate model, older age ( p = 0.039), baseline eGFR ( p <0.001) and VCY ( p = 0.069), were retained. We also observed a longer exposure to PI/b and INI in patients with lower control on HIV-RNA, expressed as VCY>2 log 10 . Our study outlines a progressive eGFR reduction in young adults with PHIV, related to the lower control on HIV-RNA VCY and related to aging.

Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997–2019

“…In the modern ART era, with life expectancy extended approximately 20 years since 2000 among PWH with access to care [ 2 ], it is critical to ascertain HIV care metrics not only predictive of death but also of aging-related NACM development. Recent analyses have demonstrated that cumulative HIV-1 viremia is associated with incident myocardial infarction [ 18 , 24 ], hypertension [ 25 ], renal insufficiency [ 26 , 27 ], and non-AIDS cancer [ 28 ]. Our study uniquely adds to this growing body of literature by assessing multimorbidity as a composite outcome and by focusing on women, a group traditionally underrepresented in HIV research although uniquely at risk of NACM [ 5 , 37 , 38 , 39 ].…”

“…Measures of cumulative HIV-1 viremia have been associated with mortality among ART-treated PWH [ 18 , 19 , 20 , 21 , 22 ] (even independent of CD4 count) [ 23 ], and with individual NACM including myocardial infarction [ 18 , 24 ], hypertension [ 25 ], renal insufficiency [ 26 , 27 ], and non-acquired immune deficiency syndrome (AIDS) cancer [ 28 ]. However, previous studies evaluating cumulative HIV-1 viremia as a prognosticator of non-AIDS mortality and morbidity have comprised male-predominant cohorts and have not assessed the effect of virologic nonsuppression on aging-related multimorbidity.…”

Persistence of Unintegrated HIV DNA Associates With Ongoing NK Cell Activation and CD34+DNAM-1brightCXCR4+ Precursor Turnover in Vertically Infected Patients Despite Successful Antiretroviral Treatment

“…In this context, viremia copy years (VCY), a metric of cumulative HIV RNA burden calculated based on longitudinal viral load data, has been used to summarize in a single value the viral burden of years ( 35 , 36 ). VCY is considered a reliable marker of past viral burden and has been associated with mortality and organ damage in people living with HIV and PHIV ( 36 , 37 ).…”