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  4th IAS (Intl AIDS Society) Conference on HIV Pathogenesis, Treatment and Prevention
Sydney, Australia
22-25 July 2007
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Six Factors Predict Kidney Problems in French HIV Cohort
 
 
  4th IAS Conference on HIV Pathogenesis, Treatment, and Prevention
July 22-25, 2007
Sydney, Australia
 
Mark Mascolini
 
Taking tenofovir and light weight predicted compromised kidney function in the Aquitaine HIV cohort of southwest France [1]. But being older than 50 proved the biggest risk factor in this 2588-person group.
 
Aquitaine researchers evaluated people for renal function once between January 2004 and August 2006. Defining renal failure as a Cockroft-Gault creatinine level below 80 mL/min, the Aquitaine team determined an overall prevalence of 22.6% (95% confidence interval 21% to 24.2%). In the cohort as a whole 17.7% had mild failure (60 to 80 mL/min creatinine), 4.4% had moderate failure (30 to 60 mL/min), 0.3% had severe failure (10 to 30 mL/min), and 0.2% had end-stage failure (below 10 mL/min). The group's median creatinine stood at 96 mL/min.
 
The cohort was 75% male, and median age stood at 42 years. Most people acquired HIV sexually (42% homosexual, 31% heterosexual), and a median 10 years had passed since HIV diagnosis. Median CD4 count measured 430 and median viral load 80 copies when clinicians measured their creatinine. Half had tried a protease inhibitor and half a nonnucleoside. Most cohort members, 92%, were taking antiretrovirals, and 25% were taking tenofovir. While 22% had abnormal lipids, 7% had high blood pressure and 3% diabetes.
 
Statistical analysis adjusted for epidemiologic, clinical, biological, and therapeutic variables figured that being 41 to 50 years old (compared with 40 or younger) raised the risk of renal failure 2.47 times, while being older than 50 upped the risk more than 13 times (adjusted odds ratio 13.3 (P < 10[-4] for both age comparisons). Body mass index below 22 kg/m2 boosted the risk 3.84 times (P < 10[-4]). (The study excluded people with a body mass index below 18 or above 30, people with ascites, and pregnant women.)
 
Females had a 3.22 times higher risk of kidney problems than males (P < 10[-4]), and people who took tenofovir for more than 1 year had a 1.62 times higher risk than those who never tried tenofovir (P = 0.0016). An undetectable viral load raised the odds of renal failure 1.57 times (P = 0.0025), perhaps because good viral control indicates treatment with tenofovir and other antiretrovirals that may compromise the kidneys. People with an AIDS diagnosis ran a 1.32 times higher risk of kidney dysfunction (P = 0.0334).
 
Time since HIV diagnosis, years of nucleoside, nonnucleoside, or protease inhibitor therapy, and diabetes, high lipids, or high blood pressure did not influence the risk of renal failure.
 
The Aquitaine researchers urged that "renal function should be carefully monitored in those HIV patients with older age, low body mass index, female gender, tenofovir exposure, undetectable viral load, and AIDS."
 
Reference
1. Morlat PJM, Deti E, Lawson-Ayayi S, et al. Prevalence and factors associated with renal failure in HIV infected patients, ANRS C03 Aquitaine Cohort, France. 4th IAS Conference on HIV Pathogenesis, Treatment, and Prevention. July 22-25, 2007. Sydney. Abstract MOPEB066.