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Incidence and Predictors of Acute Renal Failure in an Urban Cohort of Patients with HIV and Hepatitis C Co-infection
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Reported by Jules Levin CROI 2009 Feb 8-12
Incidence of acute renal failure was significantly higher in patients with HIV/HCV co-infection than in patients with HCV mono-infection.
Shikha Garg*1,2, M Hoenig1,2, E Edwards3, T Heeren3, S Tumilty4, A Walley4,5, M Koziel1, and D Cotton3,4,5
1Beth Israel Deaconess Med Ctr, Boston, MA, US; 2Harvard Med Sch, Boston, MA, US; 3Boston Univ Sch of Publ Hlth, MA, US; 4Boston Med Ctr, MA, US; and 5Boston Univ Sch of Med, MA, US
Background: Co-infection with hepatitis C (HCV) significantly increases the risk of renal disease associated with HIV, but the mechanisms are not well described. We sought to determine the incidence of acute renal failure in subjects with HIV/HCV co-infection vs HCV mono-infection, and to examine HCV-specific factors and exposure to substances of abuse as predictors of incident acute renal failure.
Methods: Within a prospective cohort of patients with HIV/HCV co-infection or HCV mono-infection followed from January 2000 to December 2007, acute renal failure events were retrospectively identified as an absolute rise in creatinine (Cr) to >1.5 or relative rise of 0.5 that returned to baseline within 3 months. For patients with chronic kidney disease, acute renal failure was defined as a rise in Cr of 1.0 from baseline Cr 2 to 4.9, and 1.5 from baseline Cr ≥5. Incidence rates for first acute renal failure event were determined. Univariate and multivariate analyses using Cox proportional hazards were performed to identify predictors of acute renal failure.
Results: During the study period, 34.7% of HIV/HCV-co-infected subjects (n = 216) and 16.6% of HCV-mono-infected subjects (n = 151) developed acute renal failure. Incidence of acute renal failure in subjects with HIV/HCV vs HCV was 8.7/100 person-years and 3.5/100 person-years, respectively. The hazard ratio for acute renal failure in HIV/ HCV co-infection vs HCV mono-infection was 2.4 (95%CI 1.50 to 3.74). Significant univariate predictors of acute renal failure included black race HR 1.6 (1..07 to 2.39), hypertension HR 1..8 (1.22 to 2.67), decompensated cirrhosis HR 4.7 (2.96 to 7.41), and substance use: cocaine use HR 1.7 (1.13 to 2.61), and hazardous drinking HR 1.7 (1..08 to 2.67) within 6 months prior to study entry. HCV-specific factors including genotype and viral load were not significant in univariate or multivariate analysis. Significant independent predictors of acute renal failure, adjusted for black race, diabetes, hypertension, and HIV status, included decompensated cirrhosis HR 4.3 (2.68 to 6.88), cocaine use 1.9 (1.23 to 3.02), and heroin use HR 1.6 (1..01 to 2.60). Hazardous drinking trended towards significance with HR 1.5 (0.94 to 2.36).
Conclusions: Incidence of acute renal failure was significantly higher in patients with HIV/HCV co-infection than in patients with HCV mono-infection. Traditional risk factors for acute renal failure were confirmed including black race, hypertension, HIV co-infection, and decompensated cirrhosis. Additional independent risk factors for acute renal failure included cocaine and heroin use, while HCV-specific virologic factors including genotype and viral load were not associated with acute renal failure.
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