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Renal Function Drops With Age--and More With PIs--in London HIV Clinic
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2nd International Workshop on HIV and Aging, October 27-28, 2011, Baltimore, Maryland
Mark Mascolini
Renal function declined with age in adults on or off ART, according to analysis of the 15,000-person Chelsea and Westminster HIV cohort in London [1]. Among antiretroviral-treated people, protease inhibitors (PIs) had the biggest impact on renal function.
People 50 and older are the fastest-growing HIV age group in the United Kingdom. In England, Wales, and Northern Ireland, new HIV diagnoses in people over 49 more than doubled from 299 cases in 2000 to 710 in 2007, according to the Health Protection Agency. Kidney impairment increases with age, as well as with antiretroviral therapy, particularly with certain PIs and nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). Among people with HIV, diabetes, high blood pressure, and HIV-associated nephropathy (HIVAN) also contribute to kidney disease.
Chelsea and Westminster and Imperial College London collaborators planned this study to assess the effects of age, HIV, and antiretroviral class on renal function calculated as estimated glomerular filtration rate (eGFR). In the UK normal age-standardized eGFR is above 90 mL/min, while an eGFR between 60 and 90 mL/min denotes mildly reduced kidney function.
The analysis included 15,048 HIV-positive adults seen at Chelsea and Westminster from January 1988 through May 2011. Most (89%) were men, including a large majority of gay men (81.2%). More than two thirds of the study group (70.7%) were Caucasian, while 8.8% were African. Only 3.1% were injection drug users.
For this analysis, the researchers divided cohort members into those between 18 and 39 years old, those from 40 to 49, and those 50 or older. Average age of cohort members rose 15 years since the start of the triple-combination era.
Calculating rates by age at which eGFR was measured, the researchers found significantly lower average eGFR in over-50 older adults than in under-40 young adults (77.5 versus 83.5 mL/min, P < 0.001). Older adults also had a significantly lower average eGFR than 40-to-49 middle-aged adults (77.5 versus 80.5 mL/min, P = 0.001).
Average eGFRs differed significantly between age groups according to which of the first three antiretroviral classes they had taken:
Only NRTIs and PIs:
-- Younger adults: 82.2 mL/min (P < 0.001 versus older adults)
-- Older adults: 74.7 mL/min
-- Middle-aged adults: 79.0 mL/min (P = 0.001 versus older adults)
Only NRTIs and nonnucleosides (NNRTIs):
-- Younger adults: 83.5 mL/min (P < 0.001 versus older adults)
-- Older adults: 77.7 mL/min
-- Middle-aged adults: 80.9 mL/min (P = 0.001)
NRTIs, NNRTIs, and PIs:
-- Younger adults: 82.8 mL/min (P < 0.001 versus older adults)
-- Older adults: 74.7 mL/min
-- Middle-aged adults: 78.9 mL/min (P = 0.001 versus older adults)
Thus older adults exposed only to NRTIs and NNRTIs had a higher average eGFR (77.7 mL/min) than older adults exposed only to NRTIs and PIs (74.7 mL/min) or to all three classes (74.7 mL/min). But the between-class impact of antiretrovirals appeared to be smaller in younger people. The investigators have not yet analyzed the impact of individual antiretrovirals.
The Chelsea-Imperial College team concluded that "exposure to some antiretroviral drug classes further adds to the decline in renal function resulting from [the] natural ageing process and HIV infection."
Reference
1. Mandalia S, Westrop SJ, Beck EJ, Nelson M, Imami N, Gazzard B. Co-effect of HIV-1 infection and ageing on renal function. 2nd International Workshop on HIV and Aging. October 27-28, 2011. Baltimore, Maryland. Abstract: O_13.
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