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Chronic Renal Failure in HIV-Infected Patients: Incidence and Risk Factors (ANRS CO3 Aquitaine Cohort, France)
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Reported by Jules Levin
CROI 2010 Feb 16-19 SF
E Deti1, G Chene1,2, M-A Vandenhende2, C Cazanave2, S Geffard1, E Lazaro2, J Roger-Schmeltz2, M Bruyand1, F Bonnet1,2, and Philippe Morlat*1,2
1INSERM U897, Bordeaux, France and 2Univ Hosp Bordeaux, France
AUTHOR CONCLUSION:
The incidence of CRF among HIV-infected patients is much higher (at least 10 times) than that observed in the general population of similar age. It slightly increases over time. In addition to traditional risk factors (diabetes 1.88 hazard ratio, hyperlipidemia 2.58 hazard ratio), immunodeficiency (CD4 <200 vs >500 4.04 hazard ratio, 200-500 vs >500 1.33 hazard ratio,) and tenofovir exposure (tenofovir exposure (years) 1.43 hazard ratio) are associated with a higher incidence of CRF. Patients' care should consider these factors to decrease the incidence of CRF in this population.
ABSTRACT
Background: The incidence of chronic renal failure (CRF) among non-AIDS related complications occurring in treated HIV-infected patients is not well established. In addition, the relative importance of traditional vs HIV-related risk factors is largely unknown. The objective of this study was to estimate the incidence and study determinants of CRF in a multicenter clinic-based cohort of HIV-infected patients.
Methods: In the ANRS CO3 Aquitaine cohort, the creatinine clearance (CC) was estimated from January 2004 using the modification of diet in renal disease (MDRD) formula. Incident cases of CRF until December 2008 were defined as a CC <60 mL/min (2 consecutive measurements in a at least 3 months period). Time to the first measurement of CC<60 mL/min was calculated from the date of the 1st CC value >60 mL/min. A Cox proportional-hazards model was used to investigate risk factors.
Results: Overall, 2,613 patients were eligible for the analysis: mean age 43 years (standard deviation 10); 75% men; median delay since HIV diagnosis 10 years (IQR 3.5 to 14.5); 21% AIDS stage; 86% treated by antiretroviral therapy; median follow-up 3.4 years (IQR 2.2 to 4.0).
The average incidence rate of CRF was 12.7 cases for 1000 person-years, with a probability of 1.9% at 1 year, 3.3% at 2 years, 4 % at 3 years, and 4.4 % at 4 years.
In the multivariate analysis, the following characteristics were associated with a higher incidence of CRF: female gender: hazard ratio (HR) = 2.9 (95%CI 1.9 to 4.4); older age: HR = 2.2 (1.8 to 2.6) by 10 years; diabetes: HR = 1.9 (1.1 to 3.3); hyperlipidemia: HR = 2.6 (1.6 to 4.1); CD4 lymphocytes count: <200/mm3 HR = 4.04 vs >500/mm3 (2.3 to 7.1); and tenofovir: HR = 1.4 (1.1 to 1.8) by additional year of exposure.
Conclusion: Among HIV-infected patients largely exposed to antiretroviral therapy, the incidence of CRF, although moderate, is much higher than that observed in the general population and slightly increases over time. In addition to traditional risk factors, immunodeficiency and tenofovir exposure are associated with CRF. Patients' care should consider these factors to reduce the incidence of CRF in this population.
RESULTS
2,613 patients were eligible for the analysis
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