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The Kidney and HIV
This document discusses HIV and its impact on the kidney. It begins with biographical information about the author, Joel M. Topf, MD, a clinical nephrologist. It then covers topics like the history of HIV, the identification of HIVAN (HIV-associated nephropathy) as a renal manifestation of HIV, characteristics of HIVAN such as its association with African Americans, and changes in HIV renal disease over time with the introduction of antiretroviral therapy. It provides data on prevalence of HIVAN from renal biopsies and risk factors associated with HIVAN compared to other kidney conditions in HIV+ patients.
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Editor's Notes
- #13 Methods: AA participants in 2 Baltimore-based cohort studies were included in this analysis: the
- #14 Johns Hopkins HIV Cohort, a clinic-based cohort of HIV(+) participants, and the ALIVE study, a
- #15 community-based cohort of HIV(-) and HIV(+) injection drug users. ESRD/RRT was determined by
- #16 matching participant identifiers with the US Renal Data System. Standardized incidence ratios (SIR)
- #17 and poison regression were used to compare to age-matched AA in the general population and to
- #18 assess for temporal trends, respectively. We compared ESRD/RRT trends with those of chronic
- #19 kidney disease (CKD) incidence and prevalence. CKD was defined as GFR<60ml/min/1.73m2 for > 3
- #20 months.
- #21 Results: RRT was initiated in 24 HIV(-) subjects during 13,415 person-years (PY) of follow-up, 51
- #22 HIV(+) participants without AIDS during 10,780 PY, and 125 participants with AIDS during 9,833 PY,
- #23 corresponding to SIRs of 2.3 (95% CI 1.5-3.4), 6.9 (95% CI 5.1-9.0), and 16.1 (95% CI 13.4-19.2),
- #24 respectively. In HIV(+) African American participants RRT incidences were 5.8 and 9.7 per 1,000 PY
- #25 in the pre-HAART and HAART eras, respectively (adjusted incidence rate ratio 1.2, 95% 0.8-1.9). In
- #26 supplementary analyses, we found that, while CKD incidence declined significantly in the HAART era
- #27 compared to the pre-HAART era, CKD period prevalence increased.
- #28 Conclusions: The ESRD/RRT rate is high in HIV(+) AAs and has not decreased appreciably in this
- #29 cohort with the widespread use of HAART. While CKD incidence has declined significantly in the
- #30 HAART era, CKD prevalence has increased as patients live longer.
- #31 In this population the incidence of CKD is decreasing. TDF use is increasing.
- #35 VA study which raised the question does haart reduce mortality despite increasing metabolic abnormalities
- #37 retrospective study
- #39 36,766 who received care at VA from 93-2001
- #45 DAD study prospective observational of 23,000 11 cohorts europe and NA
- #46 looked at association of AMI and exposure to nonNucs and PIs
- #47 better vetted events than VA study
- #67 Average GFR > 100
- #68 CD4 250
- #69 No patients on ART
- #70 No outcome data