The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection

Lynda Anne Szczech, Samir Gupta, Ramez Habash, Antonio Guasch, Robert Kalayjian, Richard Appel, Timothy A. Fields, Laura P. Svetkey, Katherine H. Flanagan, Paul E. Klotman, Jonathan A. Winston

Research output: Contribution to journalArticle

255 Citations (Scopus)

Abstract

Background. While an understanding of the epidemiology and clinical course of HIV-associated nephropathy (HIVAN) is growing, little is known about the risk factors and clinical course of the other renal diseases that may also occur as a complication of HIV infection. This study was undertaken to compare HIVAN to the spectrum of other kidney diseases seen among HIV-infected patients. Methods. This retrospective cohort study included all HIV-infected patients who underwent renal biopsy during the course of their clinical care at six major medical centers. Demographic and clinical information were abstracted from each patient's clinical record. Time to initiation of renal replacement therapy was compared for patients with lesions other than HIVAN to patients with HIVAN using Cox proportional hazards regression. Results. Eighty-nine patients (47 with lesions other than HIVAN and 42 with HIVAN) were available for inclusion. Patients with lesions other than HIVAN were less likely to be black (37/47 vs. 42/42, P = 0.02), more likely to have a positive hepatitis B surface antigen (10/37 vs. 4/42, P = 0.04), less likely to have the diagnosis of hypertension (24/46 vs. 31/42, P = 0.03), more likely to have a greater creatinine clearance at time of biopsy (60.6 vs. 39.0 cc/min, P = 0.008), and have a greater CD4 lymphocyte count at time of biopsy (287 vs. 187 cells/mL, P = 0.04) compared to patients with HIVAN. Lesions other than HIVAN were associated with a longer time to initiation of renal replacement therapy compared with HIVAN (HR 0.33, 95% CI 0.15-0.71, P = 0.005). Other factors associated with a longer time to renal replacement therapy included higher creatinine clearance at time of biopsy, greater CD4+ lymphocyte count, the absence of hepatitis C antibody, and the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The type of renal disease (HIVAN vs. other) interacted significantly with HIV-1 RNA level and the use of antiretroviral therapy (P = 0.0001 and 0.006, respectively). Among patients with lesions other than HIVAN, the presence of nondetectable HIV-1 RNA was not associated with a greater risk of progression of renal disease (HR 0.27, P = 0.24). Among patients with HIVAN, because all patients had detectable virus at the time of institution of renal replacement therapy, this highly significant association could not be quantified. Among patients with lesions other than HIVAN, the use of antiretroviral therapy was not associated with the progression to renal replacement therapy (HR 3.29, P = 0.06). Among patients with HIVAN, the use of antiretroviral therapy was associated with a slower progression to renal replacement therapy (HR 0.24, P = 0.03). Conclusion. Among HIV-infected patients with renal disease other than HIVAN, viral suppression and the use of antiretroviral therapy are not associated with a beneficial effect on renal function; thus, additional therapeutic strategies may need to be utilized. Because renal histology is associated with prognostic differences, these data provide outcomes information that will improve the clinical utility of renal biopsy among HIV-infected patients with renal disease.

Original languageEnglish (US)
Pages (from-to)1145-1152
Number of pages8
JournalKidney International
Volume66
Issue number3
DOIs
StatePublished - Sep 2004
Externally publishedYes

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AIDS-Associated Nephropathy
HIV Infections
Epidemiology
Kidney
Renal Replacement Therapy
Biopsy
HIV
CD4 Lymphocyte Count
HIV-1
Creatinine
RNA
Therapeutics

Keywords

  • Antiretroviral medications
  • Hepatitis C
  • HIV-1
  • HIVAN

ASJC Scopus subject areas

  • Nephrology

Cite this

The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. / Szczech, Lynda Anne; Gupta, Samir; Habash, Ramez; Guasch, Antonio; Kalayjian, Robert; Appel, Richard; Fields, Timothy A.; Svetkey, Laura P.; Flanagan, Katherine H.; Klotman, Paul E.; Winston, Jonathan A.

In: Kidney International, Vol. 66, No. 3, 09.2004, p. 1145-1152.

Research output: Contribution to journalArticle

Szczech, LA, Gupta, S, Habash, R, Guasch, A, Kalayjian, R, Appel, R, Fields, TA, Svetkey, LP, Flanagan, KH, Klotman, PE & Winston, JA 2004, 'The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection', Kidney International, vol. 66, no. 3, pp. 1145-1152. https://doi.org/10.1111/j.1523-1755.2004.00865.x
Szczech, Lynda Anne ; Gupta, Samir ; Habash, Ramez ; Guasch, Antonio ; Kalayjian, Robert ; Appel, Richard ; Fields, Timothy A. ; Svetkey, Laura P. ; Flanagan, Katherine H. ; Klotman, Paul E. ; Winston, Jonathan A. / The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. In: Kidney International. 2004 ; Vol. 66, No. 3. pp. 1145-1152.
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abstract = "Background. While an understanding of the epidemiology and clinical course of HIV-associated nephropathy (HIVAN) is growing, little is known about the risk factors and clinical course of the other renal diseases that may also occur as a complication of HIV infection. This study was undertaken to compare HIVAN to the spectrum of other kidney diseases seen among HIV-infected patients. Methods. This retrospective cohort study included all HIV-infected patients who underwent renal biopsy during the course of their clinical care at six major medical centers. Demographic and clinical information were abstracted from each patient's clinical record. Time to initiation of renal replacement therapy was compared for patients with lesions other than HIVAN to patients with HIVAN using Cox proportional hazards regression. Results. Eighty-nine patients (47 with lesions other than HIVAN and 42 with HIVAN) were available for inclusion. Patients with lesions other than HIVAN were less likely to be black (37/47 vs. 42/42, P = 0.02), more likely to have a positive hepatitis B surface antigen (10/37 vs. 4/42, P = 0.04), less likely to have the diagnosis of hypertension (24/46 vs. 31/42, P = 0.03), more likely to have a greater creatinine clearance at time of biopsy (60.6 vs. 39.0 cc/min, P = 0.008), and have a greater CD4 lymphocyte count at time of biopsy (287 vs. 187 cells/mL, P = 0.04) compared to patients with HIVAN. Lesions other than HIVAN were associated with a longer time to initiation of renal replacement therapy compared with HIVAN (HR 0.33, 95{\%} CI 0.15-0.71, P = 0.005). Other factors associated with a longer time to renal replacement therapy included higher creatinine clearance at time of biopsy, greater CD4+ lymphocyte count, the absence of hepatitis C antibody, and the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The type of renal disease (HIVAN vs. other) interacted significantly with HIV-1 RNA level and the use of antiretroviral therapy (P = 0.0001 and 0.006, respectively). Among patients with lesions other than HIVAN, the presence of nondetectable HIV-1 RNA was not associated with a greater risk of progression of renal disease (HR 0.27, P = 0.24). Among patients with HIVAN, because all patients had detectable virus at the time of institution of renal replacement therapy, this highly significant association could not be quantified. Among patients with lesions other than HIVAN, the use of antiretroviral therapy was not associated with the progression to renal replacement therapy (HR 3.29, P = 0.06). Among patients with HIVAN, the use of antiretroviral therapy was associated with a slower progression to renal replacement therapy (HR 0.24, P = 0.03). Conclusion. Among HIV-infected patients with renal disease other than HIVAN, viral suppression and the use of antiretroviral therapy are not associated with a beneficial effect on renal function; thus, additional therapeutic strategies may need to be utilized. Because renal histology is associated with prognostic differences, these data provide outcomes information that will improve the clinical utility of renal biopsy among HIV-infected patients with renal disease.",
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TY - JOUR

T1 - The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection

AU - Szczech, Lynda Anne

AU - Gupta, Samir

AU - Habash, Ramez

AU - Guasch, Antonio

AU - Kalayjian, Robert

AU - Appel, Richard

AU - Fields, Timothy A.

AU - Svetkey, Laura P.

AU - Flanagan, Katherine H.

AU - Klotman, Paul E.

AU - Winston, Jonathan A.

PY - 2004/9

Y1 - 2004/9

N2 - Background. While an understanding of the epidemiology and clinical course of HIV-associated nephropathy (HIVAN) is growing, little is known about the risk factors and clinical course of the other renal diseases that may also occur as a complication of HIV infection. This study was undertaken to compare HIVAN to the spectrum of other kidney diseases seen among HIV-infected patients. Methods. This retrospective cohort study included all HIV-infected patients who underwent renal biopsy during the course of their clinical care at six major medical centers. Demographic and clinical information were abstracted from each patient's clinical record. Time to initiation of renal replacement therapy was compared for patients with lesions other than HIVAN to patients with HIVAN using Cox proportional hazards regression. Results. Eighty-nine patients (47 with lesions other than HIVAN and 42 with HIVAN) were available for inclusion. Patients with lesions other than HIVAN were less likely to be black (37/47 vs. 42/42, P = 0.02), more likely to have a positive hepatitis B surface antigen (10/37 vs. 4/42, P = 0.04), less likely to have the diagnosis of hypertension (24/46 vs. 31/42, P = 0.03), more likely to have a greater creatinine clearance at time of biopsy (60.6 vs. 39.0 cc/min, P = 0.008), and have a greater CD4 lymphocyte count at time of biopsy (287 vs. 187 cells/mL, P = 0.04) compared to patients with HIVAN. Lesions other than HIVAN were associated with a longer time to initiation of renal replacement therapy compared with HIVAN (HR 0.33, 95% CI 0.15-0.71, P = 0.005). Other factors associated with a longer time to renal replacement therapy included higher creatinine clearance at time of biopsy, greater CD4+ lymphocyte count, the absence of hepatitis C antibody, and the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The type of renal disease (HIVAN vs. other) interacted significantly with HIV-1 RNA level and the use of antiretroviral therapy (P = 0.0001 and 0.006, respectively). Among patients with lesions other than HIVAN, the presence of nondetectable HIV-1 RNA was not associated with a greater risk of progression of renal disease (HR 0.27, P = 0.24). Among patients with HIVAN, because all patients had detectable virus at the time of institution of renal replacement therapy, this highly significant association could not be quantified. Among patients with lesions other than HIVAN, the use of antiretroviral therapy was not associated with the progression to renal replacement therapy (HR 3.29, P = 0.06). Among patients with HIVAN, the use of antiretroviral therapy was associated with a slower progression to renal replacement therapy (HR 0.24, P = 0.03). Conclusion. Among HIV-infected patients with renal disease other than HIVAN, viral suppression and the use of antiretroviral therapy are not associated with a beneficial effect on renal function; thus, additional therapeutic strategies may need to be utilized. Because renal histology is associated with prognostic differences, these data provide outcomes information that will improve the clinical utility of renal biopsy among HIV-infected patients with renal disease.

AB - Background. While an understanding of the epidemiology and clinical course of HIV-associated nephropathy (HIVAN) is growing, little is known about the risk factors and clinical course of the other renal diseases that may also occur as a complication of HIV infection. This study was undertaken to compare HIVAN to the spectrum of other kidney diseases seen among HIV-infected patients. Methods. This retrospective cohort study included all HIV-infected patients who underwent renal biopsy during the course of their clinical care at six major medical centers. Demographic and clinical information were abstracted from each patient's clinical record. Time to initiation of renal replacement therapy was compared for patients with lesions other than HIVAN to patients with HIVAN using Cox proportional hazards regression. Results. Eighty-nine patients (47 with lesions other than HIVAN and 42 with HIVAN) were available for inclusion. Patients with lesions other than HIVAN were less likely to be black (37/47 vs. 42/42, P = 0.02), more likely to have a positive hepatitis B surface antigen (10/37 vs. 4/42, P = 0.04), less likely to have the diagnosis of hypertension (24/46 vs. 31/42, P = 0.03), more likely to have a greater creatinine clearance at time of biopsy (60.6 vs. 39.0 cc/min, P = 0.008), and have a greater CD4 lymphocyte count at time of biopsy (287 vs. 187 cells/mL, P = 0.04) compared to patients with HIVAN. Lesions other than HIVAN were associated with a longer time to initiation of renal replacement therapy compared with HIVAN (HR 0.33, 95% CI 0.15-0.71, P = 0.005). Other factors associated with a longer time to renal replacement therapy included higher creatinine clearance at time of biopsy, greater CD4+ lymphocyte count, the absence of hepatitis C antibody, and the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The type of renal disease (HIVAN vs. other) interacted significantly with HIV-1 RNA level and the use of antiretroviral therapy (P = 0.0001 and 0.006, respectively). Among patients with lesions other than HIVAN, the presence of nondetectable HIV-1 RNA was not associated with a greater risk of progression of renal disease (HR 0.27, P = 0.24). Among patients with HIVAN, because all patients had detectable virus at the time of institution of renal replacement therapy, this highly significant association could not be quantified. Among patients with lesions other than HIVAN, the use of antiretroviral therapy was not associated with the progression to renal replacement therapy (HR 3.29, P = 0.06). Among patients with HIVAN, the use of antiretroviral therapy was associated with a slower progression to renal replacement therapy (HR 0.24, P = 0.03). Conclusion. Among HIV-infected patients with renal disease other than HIVAN, viral suppression and the use of antiretroviral therapy are not associated with a beneficial effect on renal function; thus, additional therapeutic strategies may need to be utilized. Because renal histology is associated with prognostic differences, these data provide outcomes information that will improve the clinical utility of renal biopsy among HIV-infected patients with renal disease.

KW - Antiretroviral medications

KW - Hepatitis C

KW - HIV-1

KW - HIVAN

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