Document Detail


Prevalence and factors associated with renal dysfunction among HIV-infected patients.
MedLine Citation:
PMID:  20515419     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Renal dysfunction is an increasingly recognized non-AIDS-defining comorbidity among HIV-infected persons. The role of HIV-related factors in renal dysfunction remains unclear. We performed a cross-sectional study at two military clinics with open access to care to determine the impact of HIV factors, including antiretroviral therapy, on renal function. Renal dysfunction was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m(2). We evaluated 717 HIV patients with a median age of 41 years; 92% were male, 49% Caucasian, and 38% African American; median CD4 count was 515 cells/mm(3) and 73% were receiving highly active antiretroviral therapy (HAART). Twenty-two patients (3%) had renal dysfunction. Factors associated with renal dysfunction in the multivariate logistic analyses included older age (odds ratio [OR] 2.0 per 10 year increase, p = 0.006), lower CD4 nadir (OR 0.6 per 100 cell change, p = 0.02), and duration of tenofovir use (OR 1.5 per year use, p = 0.01). Among persons initiating tenofovir (n = 241), 50% experienced a reduction in GFR (median -10.5 mL/min/1.73 m(2), 95% CI, -8.9 to -13.3) within 2 years. Among tenofovir users, factors associated with a reduction in GFR included female gender (p < 0.001), African American ethnicity (p = 0.003), and lower CD4 nadir (p = 0.002). In summary, renal dysfunction was relatively uncommon among our HIV-infected patients, perhaps due to their young age, lack of comorbidities, or as a result of our definition that did not include proteinuria. Renal dysfunction was associated with duration of tenofovir use. Factors associated with renal loss among tenofovir users included female gender, African American ethnicity, and CD4 nadir <200 cells/mm(3). Consideration for more frequent monitoring of kidney function among these select HIV patients may be warranted.
Authors:
Nancy Crum-Cianflone; Anuradha Ganesan; Nimfa Teneza-Mora; Mark Riddle; Sheila Medina; Irma Barahona; Stephanie Brodine
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  AIDS patient care and STDs     Volume:  24     ISSN:  1557-7449     ISO Abbreviation:  AIDS Patient Care STDS     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-22     Completed Date:  2010-10-04     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  9607225     Medline TA:  AIDS Patient Care STDS     Country:  United States    
Other Details:
Languages:  eng     Pagination:  353-60     Citation Subset:  IM; X    
Affiliation:
HIV Clinic, Naval Medical Center San Diego, San Diego, California 92134-1005, USA. nancy.crum@med.navy.mil
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MeSH Terms
Descriptor/Qualifier:
Adenine / administration & dosage,  analogs & derivatives*,  therapeutic use
Adult
Anti-HIV Agents* / administration & dosage,  therapeutic use
Antiretroviral Therapy, Highly Active
Cross-Sectional Studies
Female
Glomerular Filtration Rate
HIV Infections / complications*,  drug therapy
HIV-1
Humans
Kidney / drug effects
Kidney Diseases / epidemiology*,  etiology,  pathology,  physiopathology
Kidney Function Tests
Male
Middle Aged
Military Hygiene
Military Personnel
Organophosphonates* / administration & dosage,  therapeutic use
Prevalence
Reverse Transcriptase Inhibitors* / administration & dosage,  therapeutic use
Risk Factors
Time Factors
Grant Support
ID/Acronym/Agency:
HU0001-05-2-0011//PHS HHS; Y1-AI-5072/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Organophosphonates; 0/Reverse Transcriptase Inhibitors; 107021-12-5/tenofovir; 73-24-5/Adenine
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