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Kidney failure in Women with HIV
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Szczech LA, Gange SJ, van der Horst C, Bartlett JA, Young M, Cohen MH,
Anastos K,
Klassen PS, Svetkey LP.
Division of Nephrology, Department of Medicine, Duke University Medical
Center, Durham, North Carolina 27710, USA. szcze001@mc.duke.edu
BACKGROUND: Glomerular disease with proteinuria and renal failure are
complications of human
immunodeficiency virus (HIV) infection. While studies suggest risk factors
for both include black race and lower CD4 lymphocyte count, they have not
been established in population-based cohorts. This study examines the risk
factors for proteinuria and renal failure in a large cohort of HIV-infected
women not selected for the presence of renal disease. METHODS: This
prospective cohort includes 2059 women enrolled in the Women's Interagency
HIV study (WIHS). WIHS is a longitudinal study of the clinical course of HIV
infection in which subjects are followed biannually with a detailed exam
including urine analysis, serum creatinine, CD4 lymphocyte count, and HIV RNA
level. Proteinuria was defined as > or =+1 on urine dipstick exam on at least
two consecutive urine analyses, and renal failure was defined as a doubling
of serum creatinine. Multivariable logistic regression was used to estimate
the associations between clinical variables and the presence of proteinuria
on initial evaluation in a cross-sectional analysis. Cox proportional hazards
regression was used to estimate the associations between clinical variables
and time to renal failure among study participants with proteinuria in a
prospective longitudinal analysis.
RESULTS: Of 2057 HIV-positive women, 32% (N=671) had proteinuria on initial
evaluation. Predictors of proteinuria include increasing (log) HIV RNA level
[odds ratio (OR)=1.05], black race (OR=2.0), absolute CD4 lymphocyte count <
or =200 cells/mm3 (OR=1.41), and the presence of hepatitis C antibody
(OR=1.27; all P < 0.0001). Absolute CD4 lymphocyte count < or =200 cells/mm3
[hazard ratio (HR)=3.57, P=0.001], detectable HIV RNA level (HR=2.33,
P=0.02), increasing systolic blood pressure (HR=1.02, P=0.002), and
decreasing albumin (HR=3.33, P=0.0001) and increasing creatinine (1.67,
P=0.0001) were all associated with the development of renal failure.
CONCLUSIONS: This analysis establishes the associations between both
increasing
HIV RNA level and decreasing CD4 lymphocyte count with the presence of
proteinuria and occurrence of renal failure. Additionally, it demonstrates an
association between proteinuria and a positive hepatitis C antibody. To
lessen the presence and progression of renal disease among HIV-infected
patients, future research should focus on suppression of the HIV RNA level
and improvement in CD4 lymphocyte count.
Kidney Int 2002 Jan;61(1):195-202
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