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Low CD4 Cell Count and Impaired Renal Function (eGFR) Are Independent Risk Factors for ARF (acute renal failure) in HIV-infected Patients
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Reported by Jules Levin
CROI 2010 Feb 16-19 SF
Fowzia Ibrahim1, C Naftalin2, E Cheserem2, L Campbell1, L Bansi3, B Hendry1, C Sabin3, and F Post1,2
1King’s Coll London, UK; 2King’s Coll Hosp, London, UK; and 3Royal Free and Univ Coll London, UK
ABSTRACT
Introduction: Acute renal failure (ARF) is a serious complication of HIV infection. While the risk factors for ARF in this population have been defined, their relative importance remains unknown. We examined the incidence of ARF and risk factors for developing ARF in a large multi-ethnic HIV cohort.
Methods: All patients attending King’s College Hospital, London, UK, from 1/1999 to 12/2008 were included. ARF was defined as (1) confirmed >40% reduction in eGFR within a 3 month period and (2) nadir eGFR <60 mL/min/1.73m2, with a maximum of 1 ARF episode for every 3 months of follow up. ARF incidence rates were calculated for patients stratified by baseline and time updated covariates (CD4 cell count, HIV RNA, HAART use, and eGFR), and multivariable Poisson regression analysis was used to examine the effects of HIV parameters and renal function on ARF incidence.
Results: During the study period, 2556 patients were followed for a median of 2.5 years and had the following characteristics: median age 35 (IQR 30 to 40) years, 60% male, 60% black ethnicity, 10% hepatitis C co-infected, and median nadir CD4 cell count 213 (IQR 87 to 339) cells/mm3), 184 (7.2%) of whom experienced 202 ARF episodes (ARF incidence rate: 2.8 (95% CI: 2.46, 3.24) per 100 person-years. The median duration of ARF was 8 (4 to 27) days, the median CD4 cell count at ARF 101 (IQR 27 to 222) cells/mm3, and 56% of episodes occurred in patients not receiving HAART. ARF incidence rates increased from 1.3 (0.96 to 1.69) to 2.1 (1.56 to 2.96), 6.1 (4.50 to 8.36), 14.8 (9.91 to 22.07), and 26.1 (19.70 to 34.57) episodes per 100 person-years in patients with CD4 cell counts of >350, 200 to 350, 100 to 199, 50 to 99 and <50 cells/mm3, respectively. Similarly, the ARF incidence rates increased from 1.9 (1.59 to 2.37) to 2.7 (1.97 to 3.70), 7.8 (5.58 to 11.26) and 20.0 (14.01 to 28.65) episodes per 100 person-years in patients with eGFR ≥90, 75 to 89, 60 to 74, <60 mL/min/1.73m2. In multivariate analyses, low current CD4 cell count and reduced eGFR were independently associated with an increased risk of ARF (Table).
Conclusions: In a multi-ethnic HIV cohort with low rates of IVDU/Hepatitis C co-infection, current CD4 cell count and chronic renal impairment were independent risk factors for developing ARF.
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