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Streeck H, Maestri A, Habermann D, Crowell TA, Esber AL, Son G, Eller LA, Eller MA, Parikh AP, Horn PA, Maganga L, Bahemana E, Adamu Y, Kiweewa F, Maswai J, Owuoth J, Robb ML, Michael NL, Polyak CS, Hoffmann D, Ake JA. Dissecting drivers of immune activation in chronic HIV-1 infection. EBioMedicine 2022; 83:104182. [PMID: 35905559 PMCID: PMC9334338 DOI: 10.1016/j.ebiom.2022.104182] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/22/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background Immune activation is a significant contributor to HIV pathogenesis and disease progression. In virally-suppressed individuals on ART, low-level immune activation has been linked to several non-infectious comorbid diseases. However, studies have not been systematically performed in sub-Saharan Africa and thus the impact of demographics, ART and regional endemic co-infections on immune activation is not known. We therefore comprehensively evaluated in a large multinational African cohort markers for immune activation and its distribution in various settings. Methods 2747 specimens from 2240 people living with HIV (PLWH) and 477 without HIV from the observational African Cohort Study (AFRICOS) were analyzed for 13 immune parameters. Samples were collected along with medical history, sociodemographic and comorbidity data at 12 HIV clinics across 5 programs in Uganda, Kenya, Tanzania and Nigeria. Data were analyzed with univariate and multivariate methods such as random forests and principal component analysis. Findings Immune activation was markedly different between PLWH with detectable viral loads, and individuals without HIV across sites. Among viremic PLWH, we found that all immune parameters were significantly correlated with viral load except for IFN-α. The overall inflammatory profile was distinct between men and women living with HIV, in individuals off ART and with HIV viremia. We observed stronger differences in the immune activation profile with increasing viremia. Using machine learning methods, we found that geographic differences contributed to unique inflammatory profiles. We also found that among PLWH, age and the presence of infectious and/or noninfectious comorbidities showed distinct inflammatory patterns, and biomarkers may be used to predict the presence of some comorbidities. Interpretation Our findings show that chronic immune activation in HIV-1 infection is influenced by HIV viral load, sex, age, region and ART use. These predictors, as well as associations among some biomarkers and coinfections, influence biomarkers associated with noncommunicable diseases. Funding This work was supported by the President's Emergency Plan for AIDS Relief via a cooperative agreement between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense [W81XWH-11-2-0174, W81XWH-18-2-0040]. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25. This article was prepared while Michael A. Eller was employed at Henry M. Jackson Foundation for the Advancement of Military Medicine for the U.S. Military HIV Research Program. The views expressed are those of the authors and should not be construed to represent the positions of the US Army or the Department of Defense. The opinions expressed in this article are the author's own, and do not reflect the view of the National Institutes of Health, the U.S. Department of Health and Human Services, or the U.S. government.
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Affiliation(s)
- Hendrik Streeck
- Institute of Virology, Medical Faculty, University Bonn, Bonn, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany.
| | - Alvino Maestri
- Institute for HIV Research, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Daniel Habermann
- Bioinformatics and Computational Biophysics, University Duisburg-Essen, Essen, Germany
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Allahna L Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Gowoon Son
- Institute for HIV Research, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Michael A Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA; Vaccine Research Program, DAIDS, NIAID, NIH, Bethesda, MD, USA
| | - Ajay P Parikh
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Lucas Maganga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; HJF Medical Research International, Mbeya, Tanzania
| | - Yakubu Adamu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; U.S. Army Medical Research Directorate - Africa, Abuja, Nigeria
| | | | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; HJF Medical Research International, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya; HJF Medical Research International, Kisumu, Kenya
| | - Merlin L Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Nelson L Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Daniel Hoffmann
- Bioinformatics and Computational Biophysics, University Duisburg-Essen, Essen, Germany
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Paengsai N, Noppakun K, Jourdain G, Cressey TR, Salvadori N, Chaiwarith R, Tantraworasin A, Mary JY, Bowonwatanuwong C, Bhakeecheep S, Traisathit P, Kosachunhanun N. Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program. Healthcare (Basel) 2022; 10:healthcare10081490. [PMID: 36011147 PMCID: PMC9408286 DOI: 10.3390/healthcare10081490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Tenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney disease (CKD), especially in Asian populations. Data from the Thai national health insurance system was used to assess CKD incidence in patients receiving antiretroviral therapy in real-world practice. We analyzed data from patients who initiated one of the following first-line regimens: zidovudine + lamivudine + nevirapine (AZT + 3TC + NVP); zidovudine + lamivudine + efavirenz (AZT + 3TC + EFV); tenofovir + lamivudine + nevirapine (TDF + 3TC + NVP); tenofovir + lamivudine/emtricitabine + efavirenz (TDF + 3TC/FTC + EFV); and tenofovir +lamivudine +lopinavir/ritonavir (TDF + 3TC + LPV/r). CKD was defined as glomerular filtration rate <60 mL/min/1.73 m2 for >3 months, or a confirmed 2010 WHO diagnosis (ICD-10 code N183, N184, or N185). Death competing risk survival regression models were used. Among 27,313 participants, with a median age of 36.8 years and median follow-up of 2.3 years, 245 patients (0.9%) were diagnosed with CKD (incidence 3.2 per 1000 patient-years; 95% CI 2.8−3.6). Compared with patients receiving AZT + 3TC + NVP, the risk of CKD measured by adjusted sub-distribution hazard ratio (aSHR) was 6.5 (95% CI 3.9−11.1) in patients on TDF + 3TC + LPV/r, 3.8 (95% CI 2.3−6.0) in TDF + 3TC + NVP, and 1.6 (95% CI 1.2−2.3) in TDF + 3TC/FTC + EFV. Among patients receiving TDF, compared with those receiving TDF + 3TC/FTC + EFV, the aSHR was 4.0 (95% CI 2.3−6.8) in TDF + 3TC + LPV/r and 2.3 (95% CI 1.4−3.6) in TDF + 3TC + NVP. TDF was associated with an increased risk of CKD, especially when combined with LPV/r or NVP.
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Affiliation(s)
- Ninutcha Paengsai
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- National Health Security Office (NHSO), Bangkok 10210, Thailand
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence:
| | - Gonzague Jourdain
- Institut de Recherche pour le Développement (IRD), MIVEGEC, 13002 Marseille, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Tim Roy Cressey
- Institut de Recherche pour le Développement (IRD), MIVEGEC, 13002 Marseille, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L69 3GF, UK
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nicolas Salvadori
- Institut de Recherche pour le Développement (IRD), MIVEGEC, 13002 Marseille, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Romanee Chaiwarith
- Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Apichat Tantraworasin
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jean Yves Mary
- INSERM UMR 1135, Equipe ECSTRRA, Centre de Recherche Epidémiologie Statistique Sorbonne Paris Cité, Université Paris Diderot, 75004 Paris, France
| | | | | | - Patrinee Traisathit
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Natapong Kosachunhanun
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Shapiro AE, Ignacio RAB, Whitney BM, Delaney JA, Nance RM, Bamford L, Wooten D, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Webel AR, Kim HN, Van Rompaey SE, Christopoulos K, Jacobson J, Karris M, Smith D, Johnson MO, Willig A, Eron JJ, Hunt P, Moore RD, Saag MS, Mathews WC, Crane HM, Cachay ER, Kitahata MM. Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March-December 2020. J Acquir Immune Defic Syndr 2022; 90:369-376. [PMID: 35364600 PMCID: PMC9246864 DOI: 10.1097/qai.0000000000002989] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/03/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies. SETTING Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care. METHODS We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020-December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores. RESULTS Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm 3 [aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm 3 (aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm 3 , diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died. CONCLUSIONS PWH with CD4 count <350 cells/mm 3 , and a history of CD4 count <200 cells/mm 3 , have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.
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Affiliation(s)
| | | | | | | | | | - Laura Bamford
- University of California San Diego, San Diego, CA, USA
| | - Darcy Wooten
- University of California San Diego, San Diego, CA, USA
| | | | | | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | - Maile Karris
- University of California San Diego, San Diego, CA, USA
| | - Davey Smith
- University of California San Diego, San Diego, CA, USA
| | | | - Amanda Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph J. Eron
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Peter Hunt
- University of California, San Francisco, San Francisco, CA, USA
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Tenofovir disoproxil and renal mitochondrial toxicity: more studies in Africans are needed. AIDS 2022; 36:1047-1048. [PMID: 35652676 DOI: 10.1097/qad.0000000000003219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinicopathological correlation of kidney disease in HIV infection pre- and post-ART rollout. PLoS One 2022; 17:e0269260. [PMID: 35639767 PMCID: PMC9154109 DOI: 10.1371/journal.pone.0269260] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
The spectrum of HIV-associated kidney disease has expanded significantly with the introduction of antiretroviral therapy (ART). In the pre-ART era there was prominence of HIV-associated nephropathy (HIVAN). More recently, the spectrum of disease additionally reflects comorbid illness in the ageing HIV population and ART-related nephrotoxicity. We performed a clinicopathological correlation of kidney disease in HIV-positive individuals who underwent kidney biopsy between 1989 and 2014, utilizing the 2018 Kidney Disease Improving Global Outcomes pathologic classification. ART rollout began in 2004 in South Africa. Patients biopsied pre-ART rollout were compared to those biopsied post-ART rollout with respect to demographics, clinical parameters and histology. We assessed kidney survival in a cohort of these patients following biopsy. Six hundred and ninety biopsies were included, 99 (14.3%) were undertaken pre- and 591 (85.7%) post-ART rollout. Most patients were of Black African descent (97.5%). The post-ART rollout patients were older (p = 0.007), had higher eGFR at presentation (p = 0.016) and fewer presented with eGFR of less than 15ml/min/1.73m2 (p = 0.0008). There was a decrease in the prevalence of classic HIVAN (p = 0.00001); and an increase in FSGS (NOS) in the setting of HIV (p = 0.0022) and tubulointerstitial diseases (p = 0.009) post-ART rollout. Kidney function survival over 5 years was poorest in patients with classic HIVAN (p = 0.00005) and best in minimal change nephropathy (p = 0.0013). Kidney biopsy is crucial for the correct diagnosis and management of HIV-related kidney disease. ART rollout has shifted the spectrum of kidney disease away from classic HIVAN but has not eliminated it. Histological diagnosis prognosticates kidney survival.
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Savedchuk S, Raslan R, Nystrom S, Sparks MA. Emerging Viral Infections and the Potential Impact on Hypertension, Cardiovascular Disease, and Kidney Disease. Circ Res 2022; 130:1618-1641. [PMID: 35549373 DOI: 10.1161/circresaha.122.320873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Viruses are ubiquitous in the environment and continue to have a profound impact on human health and disease. The COVID-19 pandemic has highlighted this with impressive morbidity and mortality affecting the world's population. Importantly, the link between viruses and hypertension, cardiovascular disease, and kidney disease has resulted in a renewed focus and attention on this potential relationship. The virus responsible for COVID-19, SARS-CoV-2, has a direct link to one of the major enzymatic regulatory systems connected to blood pressure control and hypertension pathogenesis, the renin-angiotensin system. This is because the entry point for SARS-CoV-2 is the ACE2 (angiotensin-converting enzyme 2) protein. ACE2 is one of the main enzymes responsible for dampening the primary effector peptide Ang II (angiotensin II), metabolizing it to Ang-(1-7). A myriad of clinical questions has since emerged and are covered in this review. Several other viruses have been linked to hypertension, cardiovascular disease, and kidney health. Importantly, patients with high-risk apolipoprotein L1 (APOL1) alleles are at risk for developing the kidney lesion of collapsing glomerulopathy after viral infection. This review will highlight several emerging viruses and their potential unique tropisms for the kidney and cardiovascular system. We focus on SARS-CoV-2 as this body of literature in regards to cardiovascular disease has advanced significantly since the COVID-19 pandemic.
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Affiliation(s)
- Solomiia Savedchuk
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC (S.S., S.N., M.A.S.)
| | - Rasha Raslan
- Internal Medicine, Virginia Commonwealth University, Richmond (R.R.)
| | - Sarah Nystrom
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC (S.S., S.N., M.A.S.)
| | - Matthew A Sparks
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC (S.S., S.N., M.A.S.)
- Renal Section, Durham VA Health Care System, NC (M.A.S.)
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Kalyesubula R, Sekitoleko I, Tomlin K, Hansen CH, Ssebunya B, Makanga R, Mbonye MK, Seeley J, Smeeth L, Newton R, Tomlinson LA. Association of impaired kidney function with mortality in rural Uganda: results of a general population cohort study. BMJ Open 2022; 12:e051267. [PMID: 35473721 PMCID: PMC9045120 DOI: 10.1136/bmjopen-2021-051267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/08/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the association between baseline kidney function and subsequent all-cause mortality. DESIGN AND SETTING A general population-based cohort study from rural Uganda. PARTICIPANTS People aged 18 years and above with measured baseline estimated glomerular filtration rate (eGFR), recruited from survey rounds in 2011-2012 or 2014-2015 and followed up to March 2019. OUTCOME MEASURE The primary outcome was all-cause mortality, identified through reports from community health workers and verified by verbal autopsy. The association between baseline eGFR category and mortality was determined using multivariable Cox regression. RESULTS Of 5812 participants in both rounds, we included 5678 (97.7%) participants with kidney function and mortality data; the median age was 36 years (IQR 24-50), 60.7% were female, 10.3% were hypertensive, 9.8% were HIV-positive and 1.5% were diabetic. During a median follow-up of 5.0 years (IQR 3.7-6.0) there were 140 deaths. In age-adjusted and sex-adjusted analyses, eGFR <45 mL/min/1.73 m2 at baseline was associated with a 5.97 (95% CI 2.55 to 13.98) increased risk of mortality compared with those with baseline eGFR >90 mL/min/1.73 m2. After inclusion of additional confounders (HIV, body mass index, diabetes, hypertension, alcohol and smoking status) into the model, eGFR <45 mL/min/1.73 m2 at baseline remained strongly associated with mortality (HR 6.12, 95% CI 2.27 to 16.45), although the sample size fell to 3102. Test for trend showed strong evidence (p<0.001) that the rate of mortality increased progressively as the category of baseline kidney function decreased. When very high eGFR was included as a separate category in age-adjusted and sex-adjusted analyses, baseline eGFR ≥120 mL/min/1.73 m2 was associated with increased risk of mortality (HR 2.68, 95% CI 1.47 to 4.87) compared with the reference category of 90-119 mL/min/1.73 m2. CONCLUSION In a prospective cohort in rural Uganda we found that impaired baseline kidney function was associated with subsequently increased total mortality. Improved understanding of the determinants of kidney disease and its progression is needed in order to inform interventions for prevention and treatment.
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Affiliation(s)
- Robert Kalyesubula
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Physiology and Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Isaac Sekitoleko
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Keith Tomlin
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christian Holm Hansen
- Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Billy Ssebunya
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Ronald Makanga
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Moses Kwizera Mbonye
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Newton
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
| | - Laurie A Tomlinson
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Bonjoch A, Juega J, Echeverría P, Puig J, Perez-Alvarez N, Bonal J, Loste C, Clotet B, Negredo E. Prevalence, progression, and management of advanced chronic kidney disease in a cohort of people living with HIV. HIV Med 2022; 23:1078-1084. [PMID: 35470944 DOI: 10.1111/hiv.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advanced kidney disease is an emerging problem in people living with HIV despite sustained viral suppression. METHODS We performed a prospective cohort study to identify people living with HIV with advanced kidney disease according to the Kidney Disease Improving Global Outcomes criteria and to assess disease progression over a 48-week period following the offer of targeted multidisciplinary management. RESULTS From our cohort of 3090 individuals, 55 (1.8%, 95% confidence interval [CI] 1.31-2.25) fulfilled the inclusion criteria. Most were male (83.6%), and the median (interquartile range [IQR]) age was 58 (53.25-66.75) years. Nadir CD4 T-cell count was 135.5 (IQR 43.5-262.75) cells/μl, current CD4 T-cell count was 574 (IQR 438.5-816) cells/μl, and 96% had maintained HIV viral suppression. The most frequent comorbidity was arterial hypertension (85.5%). Inadequate antiretroviral dose was detected in three individuals (5.5%), and drug-drug interactions were recorded in eight (14.5%), mainly involving the use of cobicistat (n = 5 [9%]). Four individuals (7%) required modification of their concomitant treatment. Seven (13%) had to start or resume follow-up with a nephrologist. Nine participants (16.4%) experienced an improvement in kidney disease stage, three individuals (5.5%) underwent renal transplantation, and one (2%) started haemodialysis. CONCLUSIONS Our results show that a multidisciplinary approach, including a critical review of treatment and evaluation of specific requirements, could be useful for anticipating drug-drug interactions and toxicities and for reducing death and hospitalization in people living with HIV with advanced kidney disease.
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Affiliation(s)
- Anna Bonjoch
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Javier Juega
- Nephrology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Patricia Echeverría
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Puig
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Nuria Perez-Alvarez
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Department of Statistics and Operations Research, Technical University of Catalonia-Barcelona Tech, Barcelona, Spain
| | - Jordi Bonal
- Nephrology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Cora Loste
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Bonaventura Clotet
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Infectious Diseases and Immunity, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Barcelona, Spain.,AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eugènia Negredo
- Infectious Diseases Department & Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Infectious Diseases and Immunity, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Barcelona, Spain
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Raubinger S, Lee FJ, Pinto AN. HIV: the changing paradigm. Intern Med J 2022; 52:542-549. [PMID: 35419962 DOI: 10.1111/imj.15739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
The past four decades have seen enormous progress in the diagnosis and management of human immunodeficiency virus (HIV) infection. There have been significant advances spanning the approval of the first antiretroviral agents, the advent of combination antiretroviral therapy to single tablet regimens with minimal toxicity. Although these remarkable developments have on the surface led to the 'end of AIDS', there are still key populations being left behind. This clinical update will describe the diagnosis and management of HIV, and the changing paradigms that have seen HIV transform from a life-limiting condition to a manageable chronic disease over a few decades.
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Affiliation(s)
- Sian Raubinger
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Frederick J Lee
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Angie N Pinto
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Shi R, Chen X, Lin H, Ding Y, He N. Incidence of impaired kidney function among people with HIV: a systematic review and meta-analysis. BMC Nephrol 2022; 23:107. [PMID: 35300612 PMCID: PMC8932163 DOI: 10.1186/s12882-022-02721-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/02/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In the era of combination antiretroviral therapy (ART), the incidence, manifestations and severity of kidney diseases have dramatically changed in people living with HIV (PLWH). Little is known about the incidence of impaired kidney function (IKF) measured by serum creatine-based estimated glomerular filtration rate (eGFR) in PLWH. METHODS In this systematic review and meta-analysis, we searched PubMed, Ovid, Medline, Embase and Web of Science for studies published before May 7th, 2021, with estimates of incidence of IKF among PLWH. We independently reviewed each study for quality by using the Newcastle-Ottawa scale. The incidence and 95% confidence intervals (CIs) were calculated using random-effects model. RESULTS Sixty out of 3797 identifiable studies were eligible for the meta-analysis. A total of 19 definitions of IKF were described and categorized into three types: the threshold of eGFR, an absolute or percent decrease in eGFR, and certain eGFR threshold combined with decrement in eGFR. The eGFR< 60 ml/min/1.73m2 was the most widely used definition or criterion for IKF, by which the pooled incidence rate of IKF was 12.50 (95%CI: 9.00-17.36) per 1000 person years (PYs). The second most-studied outcome was a > 25% decrease in eGFR, followed by eGFR< 90 ml/min/1.73m2, eGFR< 30 ml/min/1.73m2 and a combination of eGFR threshold plus decreased eGFR. The reported incidence rates of IKF differ widely by different definitions of IKF. The highest pooled incidence was observed for those with > 25% decrease in eGFR, while the lowest was observed in those with eGFR < 30 ml/min/1.73m2. Substantial heterogeneity was identified across most estimates. CONCLUSION Our study provides a comprehensive summary of eGFR-based definitions and incidence rates of IKF in PLWH, not only promoting our understanding of IKF, but also underscoring needs for a concerted action to unify definitions and outcomes of IKF and their applications in AIDS care.
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Affiliation(s)
- Ruizi Shi
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289, 138 Yi Xue Yuan Road, Shanghai, 200032, China
- Yiwu Research Institute of Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang Province, China
| | - Haijiang Lin
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289, 138 Yi Xue Yuan Road, Shanghai, 200032, China
- Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang Province, China
| | - Yingying Ding
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289, 138 Yi Xue Yuan Road, Shanghai, 200032, China
- Yiwu Research Institute of Fudan University, Shanghai, China
| | - Na He
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, P.O.Box 289, 138 Yi Xue Yuan Road, Shanghai, 200032, China.
- Yiwu Research Institute of Fudan University, Shanghai, China.
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Ma J, Zheng Q, Zhang H, Wen Y, Ye W, Ye W, Zheng K, Gao R, Chen L, Li T, Li X, Yu Y, Lyu W. The spectrum of kidney biopsy findings in Chinese HIV-infected patients. HIV Med 2022; 23 Suppl 1:23-31. [PMID: 35293105 DOI: 10.1111/hiv.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES HIV-associated kidney disease is common but data on the pathology spectrum of kidney biopsy in China is lacking. This study aimed to illustrate the clinical presentation, laboratory findings and pathological spectrum of different subtypes of HIV-associated kidney disease in China. METHODS Eighteen HIV patients with renal biopsy indications at the Peking Union Medical College Hospital from January 2002 to October 2021 were retrospectively enrolled. All had CD4 counts and HIV viral load measurements. Renal biopsies were examined with light microscopy, immunofluorescence, and electron microscopy. Shapiro-Wilk test was used to test whether the data was normally distributed. The data is presented as medians (interquartile range), number (%), or means (±SD) according to their distribution. RESULTS Seventeen patients had glomerular disease, and one patient had interstitial nephritis. Membranous nephropathy was present in eight patients (47.1%), and IgA nephropathy in four patients (23.5%). The difference in urine protein and serum albumin before and after treatment was statistically significant and no deaths or dialysis were observed to the end of follow-up. CONCLUSION This study found that classic HIV-associated nephropathy (HIVAN) was uncommon in Chinese HIV patients. HIV immune complex kidney (HIVICK) disease, such as membranous or IgA nephropathy, was more common, and associated with better prognosis. Antiretroviral therapy, ACE inhibitors, and angiotensin II receptor blockers were effective in decreasing proteinuria and preserving renal function. The use of corticosteroids and immunosuppressive agents seems safe. However, the nephrotoxic effect of antiretroviral agents and other medications should be carefully monitored.
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Affiliation(s)
- Jie Ma
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingyue Zheng
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Eight-year MD Program, Peking Union Medical College, Beijing, China
| | - Hanlin Zhang
- Eight-year MD Program, Peking Union Medical College, Beijing, China.,Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubing Wen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenling Ye
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Ye
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Zheng
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruitong Gao
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Taisheng Li
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Yu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Lyu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Kolaitis NA, Lammi M, Mazimba S, Feldman J, McConnell W, Sager JS, Raval AA, Simon MA, De Marco T. Human Immune Deficiency Virus-Associated Pulmonary Arterial Hypertension: A Report from the Pulmonary Hypertension Association Registry. Am J Respir Crit Care Med 2022; 205:1121-1124. [PMID: 35180043 DOI: 10.1164/rccm.202111-2481le] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nicholas A Kolaitis
- University of California San Francisco, 8785, Medicine, San Francisco, California, United States;
| | - Matthew Lammi
- Louisiana State University Health Sciences Center, Pulmonary/Critical Care and Allergy/Immunology, New Orleans, Louisiana, United States
| | - Sula Mazimba
- University of Virginia, 2358, Department of Medicine, Charlottesville, Virginia, United States
| | - Jeremy Feldman
- Arizona Pulmonary Specialists, Pheonix, Arizona, United States
| | - Wes McConnell
- Kentuckiana Pulmonary Associates, Louisville, Kentucky, United States
| | - Jeffrey S Sager
- Cottage Health, 7194, Pulmonary Hypertension Center, Santa Barbara, California, United States
| | - Abhijit A Raval
- AnMed Health, 169677, Anderson, South Carolina, United States
| | - Marc A Simon
- University of California San Francisco, 8785, San Francisco, California, United States
| | - Teresa De Marco
- University of California San Francisco, 8785, Medicine, San Francisco, California, United States
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Peng L, He Y, Zhang J, Hong D, Li G. Erythropoietin and iron for anemia in HIV-infected patients undergoing maintenance hemodialysis in China: a cross-sectional study. BMC Nephrol 2022; 23:60. [PMID: 35135490 PMCID: PMC8827246 DOI: 10.1186/s12882-022-02693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Anemia is a common complication of chronic kidney disease (CKD) and HIV infection. The number of people living with HIV on hemodialysis (HD) is increasing. However, there is no data about anemia and related therapies in this kind of patients in China. We aim to assess the difference in hemoglobin (Hgb) and treatments like erythropoietin and iron between HIV-HD patients and HD patients in Chengdu, China. Methods This cross-sectional study was conducted with data collection from January 2020 to June 2020. Thirty-four HIV-infected HD patients and thirty-five non-HIV-infected HD patients were included. Age, gender, dialysis vintage, single-pool (sp) Kt/V, Hgb, the dose of erythropoietin, ferritin, use of iron preparations, and serum albumin were collected in all patients. Time since HIV diagnosis, counts of CD4 + T cells, HIV RNA, and antiretroviral therapy for HIV infection were collected in HIV-infected patients. T-test, Mann–Whitney U test, and chi-square statistics were applied in SPSS. Results The Hgb of HIV-HD and HD groups were 105.70 (95.93–112.08) g/L and 112.00 (93.00–126.00) g/L respectively (P = 0.064). There was a statistically significant higher erythropoietin dosage used in the HIV-HD population (222.55 ± 115.47 U/kg/week) compared to the HIV-negative HD group (161.86 ± 110.31 U/kg/week) (P = 0.029). 16/34 (47.06%) HIV-HD patients and 5/35 (14.29%) HD patients were treated with iron preparations (P = 0.003). The ferritin levels were 316.50 (117.38–589.75) ng/ml and 272.70 (205.00–434.00) ng/ml in HIV-HD and HD groups respectively. Conclusions A higher erythropoietin dosage and a higher probability of iron preparations may be required to maintain Hgb in HIV-HD patients compared with HD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02693-y.
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Affiliation(s)
- Lei Peng
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.,School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yanan He
- Public Health Clinical Center of Chengdu, Chengdu, China
| | - Jiong Zhang
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Daqing Hong
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Guisen Li
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
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64
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Masina J, Moolla M, Motara F, Kalla IS, Laher AE. Clinical Profile of Adult Patients Presenting With Renal Dysfunction to a Tertiary Hospital Emergency Department. Cureus 2022; 14:e21873. [PMID: 35265412 PMCID: PMC8898047 DOI: 10.7759/cureus.21873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/08/2022] Open
Abstract
Background Renal dysfunction is a potentially life-threatening condition that is commonly encountered in the emergency department (ED). This study aimed to describe the clinical profile of patients presenting with renal dysfunction to a tertiary-level hospital ED. Methods Medical records of patients presenting to the ED with renal dysfunction over a six-month period (July-December 2017) were reviewed. A descriptive analysis of the data was performed. Results Serum creatinine levels were measured in 7,442 (69.9%) of the 10,642 patients that were triaged into the ED. Of these, 208 (2.8%) were identified with renal dysfunction, of which 192 consented to study participation. The median age of study subjects was 49.5 (IQR 38.8-63.0) years; 108 (56.3%) were male; proteinuria on urine dipsticks was demonstrated in 108 (56.3%); 72 (37.5%) were HIV-positive; 66 (39.6%) required dialysis; 11 (5.7%) were admitted to the ICU; and 59 (30.7%) died prior to hospital discharge. More patients presented with acute kidney injury (AKI) (46.9%) compared to chronic kidney disease (CKD) (27.6%) and acute on chronic kidney disease (AoCKD) (25.5%). Sepsis was the most common precipitant of AKI (42.2%) and AoCKD (30.6%), while chronic hypertension (35.8%) and diabetes mellitus (34.0%) were the most common comorbidities in subjects with CKD. Conclusion Patients presenting to the ED with various risk factors and comorbidities, including HIV, sepsis, hypertension, and diabetes mellitus, may have underlying renal dysfunction. ED clinicians should therefore adopt a low threshold to screen for renal dysfunction in these patients.
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Affiliation(s)
- John Masina
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Muhammed Moolla
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Feroza Motara
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Ismail S Kalla
- Internal Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Abdullah E Laher
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
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65
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Shi R, Chen X, Lin H, Shen W, Xu X, Zhu B, Xu X, Ding Y, He N. Interaction of sex and HIV infection on renal impairment: baseline evidence from the CHART cohort. Int J Infect Dis 2022; 116:182-188. [PMID: 35017104 DOI: 10.1016/j.ijid.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/07/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Females are more vulnerable to renal impairment (RI) in people living with HIV (PLWH), but few studies have examined sex disparity in the association of HIV serostatus with RI. METHODS In total, 2,101 PLWH on antiretroviral treatment (ART) and 4,202 HIV-negative people were selected and frequency matched in 1:2 ratio by sex and age categories. RI was defined as estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2. The interaction effect of sex with HIV serostatus and correlates of RI were assessed by logistic regression models. RESULTS In total, 78.2% of participants were males with median age 43.7 (IQR: 32.5-54.4) years. The prevalence of RI was comparable for PLWH and HIV-negative people overall (30.4% vs 30.1%) but significantly higher for HIV-positive females (37.1%) than HIV-negative females (30.1%). Multiple logistic regression identified an interaction between sex and HIV serostatus on RI (adjusted odds ratio [aOR] of the interaction term: 1.66, 95% CI: 1.23-2.26). HIV infection was significantly associated with RI in females (aOR: 1.55, 95% CI: 1.17-2.06) but not in males. Central obesity and nadir CD4 count were significantly associated with RI in HIV-infected females but not in HIV-infected males. CONCLUSIONS Sex seems to modify the association between HIV infection and RI, suggesting a sex-specific mechanistic pathogenesis of RI in PLWH, which warrants further investigation and intervention.
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Affiliation(s)
- Ruizi Shi
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Haijiang Lin
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Xiaohui Xu
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Bowen Zhu
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaoyi Xu
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yingying Ding
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Diseases and Biosecurity, Fudan University, Shanghai, China; Yi-Wu Research Institute, Fudan University, Shanghai, China.
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Adnani H, Agrawal N, Khatri A, Vialet J, Zhang M, Cervia J. Impact of Antiretroviral Therapy on Kidney Disease in HIV Infected Individuals - A Qualitative Systematic Review. J Int Assoc Provid AIDS Care 2022; 21:23259582221089194. [PMID: 35369795 PMCID: PMC8984856 DOI: 10.1177/23259582221089194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Kidney disease is the fourth most common cause of non-AIDS-related mortality in
people living with HIV. Combination antiretroviral therapy (cART) remains the
cornerstone of treatment. However, little is known about the impact of cART on
disease outcomes in patients with HIV-associated nephropathy (HIVAN) and
HIV-immune complex kidney disease (HIVICK). This systematic review evaluates the
impact of cART on progression to end-stage kidney disease (ESKD) and other
outcomes in HIV-infected individuals. We conducted a literature search utilizing
PubMed, and Cochrane database and 11 articles met inclusion criteria for
analysis of which nine HIVAN studies showed decreased progression to ESKD or
death for subjects when treated with cART versus those untreated. However, two
studies showed no survival advantage with cART. Three HIVICK studies showed
improvement in delaying ESKD in subjects on cART compared to untreated subjects.
cART appeared to reduce the risk to ESKD or death in patients with both HIVAN
and HIVICK.
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Affiliation(s)
- Harsha Adnani
- 490225Anne Arundel Medical Center, Annapolis, Maryland, USA
| | - Nirav Agrawal
- 88982Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Akshay Khatri
- Division of Infectious Diseases, Department of Medicine, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jaclyn Vialet
- North Shore University Hospital, Clinical Medical Library, Manhasset, New York, USA
| | - Meng Zhang
- 88982Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Joseph Cervia
- Division of Infectious Diseases, Department of Medicine, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,24945North Shore University Hospital, Manhasset, New York, USA.,232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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67
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Naicker S, Dix-Peek T, Klar RM, Kalunga G, Mosiane P, Dickens C, Duarte R. Profiling Biomarkers in HIV Glomerular Disease – Potential for the Non-Invasive Diagnosis of HIVAN? Int J Nephrol Renovasc Dis 2021; 14:427-440. [PMID: 34916827 PMCID: PMC8668162 DOI: 10.2147/ijnrd.s331484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background There is a wide spectrum of kidney pathology in human immunodeficiency virus (HIV) infection, affecting all structures of the kidney. The histology of HIV chronic kidney disease (CKD) is diverse, ranging from HIV-associated nephropathy (HIVAN) to focal glomerulosclerosis (FSGS), HIV-immune complex disease (HIV-ICD), other glomerulopathies and tubulo-interstitial nephritis. Definitive diagnosis is by kidney biopsy, an invasive procedure. However, serum and urinary biomarkers may be useful in predicting the histological diagnosis of HIVAN. Purpose We wished to determine the utility of serum and urinary biomarkers in predicting the histological diagnosis of HIVAN. Patients and Methods We measured neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, transforming growth factor (TGF)-β isoforms and bone morphogenetic protein (BMP)-7 in the serum and urine in patients with different histological forms of HIV glomerular disease. Results In HIVAN, we demonstrated increased levels of serum cystatin C and increased levels of serum and urinary NGAL. Urinary TGF-β1 and TGF-β2 levels were elevated in HIV-positive patients with CKD but were not significantly different in the different HIV histologies, while urinary BMP-7 levels were elevated in minimal change disease. Conclusion This study confirmed the presence of increased serum and urinary biomarkers of tubular injury in patients with HIVAN, and increased urinary biomarkers of fibrosis in HIV CKD, and may indicate their value as a non-invasive diagnostic tool for the diagnosis of HIVAN.
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Affiliation(s)
- Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Correspondence: Saraladevi Naicker Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaTel +27 83 6429575 Email
| | - Therese Dix-Peek
- Department of Internal Medicine Laboratory, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roland Manfred Klar
- Department of Internal Medicine Laboratory, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Glendah Kalunga
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pulane Mosiane
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Dickens
- Department of Internal Medicine Laboratory, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raquel Duarte
- Department of Internal Medicine Laboratory, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kudose S, Santoriello D, Bomback AS, Sekulic M, Batal I, Stokes MB, Ghavami IA, Kim JS, Marasa M, Xu K, Peleg Y, Barasch J, Canetta P, Rasouly HM, Gharavi AG, Markowitz GS, D’Agati VD. Longitudinal Outcomes of COVID-19-Associated Collapsing Glomerulopathy and Other Podocytopathies. J Am Soc Nephrol 2021; 32:2958-2969. [PMID: 34670811 PMCID: PMC8806099 DOI: 10.1681/asn.2021070931] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The long-term outcome of COVID-19-associated collapsing glomerulopathy is unknown. METHODS We retrospectively identified 76 native kidney biopsies from patients with history of COVID-19 between March 2020 and April 2021. Presenting and outcome data were obtained for all 23 patients with collapsing glomerulopathy and for seven patients with noncollapsing podocytopathies. We performed APOL1 genotyping by Sanger sequencing, immunostaining for spike and nucleocapsid proteins, and in situ hybridization for SARS-CoV-2. RESULTS The 23 patients with COVID-19-associated collapsing glomerulopathy were median age 57 years (range, 35-72), included 16 men, and were predominantly (91%) Black. Severity of COVID-19 was mild or moderate in most (77%) patients. All but one patient presented with AKI, 17 had nephrotic-range proteinuria, and six had nephrotic syndrome. Fourteen (61%) patients required dialysis at presentation. Among 17 patients genotyped, 16 (94%) were high-risk APOL1. Among 22 (96%) patients with median follow-up at 155 days (range, 30-412), 11 (50%) received treatment for COVID-19, and eight (36%) received glucocorticoid therapy for podocytopathy. At follow-up, 19 (86%) patients were alive, and 15 (68%) were dialysis free, including seven of 14 who initially required dialysis. The dialysis-free patients included 64% (seven of 11) of those treated for COVID-19 and 75% (six of eight) of those treated with glucocorticoids for podocytopathy. Overall, 36% achieved partial remission of proteinuria, 32% had no remission, and 32% reached combined end points of ESKD or death. Viral infection of the kidney was not detected. CONCLUSIONS Half of 14 patients with COVID-19-associated collapsing glomerulopathy requiring dialysis achieved dialysis independence, but the long-term prognosis of residual proteinuric CKD remains guarded, indicating a need for more effective therapy.
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Affiliation(s)
- Satoru Kudose
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Dominick Santoriello
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Andrew S. Bomback
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Miroslav Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Ibrahim Batal
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - M. Barry Stokes
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Iman A. Ghavami
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Jung S. Kim
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Maddalena Marasa
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Katherine Xu
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Yonatan Peleg
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Jonathan Barasch
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Pietro Canetta
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Hila Milo Rasouly
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Ali G. Gharavi
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York
| | - Glen S. Markowitz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Vivette D. D’Agati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
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Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is common in people living with HIV (PLWH) and is related to a multitude of factors. The aim of this review is to provide an overview of the most recent evidence of renal adverse effects of antiretroviral drugs, predictors of CKD risk and areas for future research. RECENT FINDINGS Advancing age, cardiometabolic risk factors and adverse effects of antiretroviral drugs contribute to the higher prevalence of CKD in PLWH. Genetic factors and baseline clinical CKD risk are strongly correlated to risk of incident CKD, although it is unclear to what extent gene polymorphisms explain renal adverse effects related to tenofovir disoproxil fumarate (TDF). Switching from TDF to tenofovir alafenamide (TAF) in people with baseline renal dysfunction improves renal parameters; however, the long-term safety and benefit of TAF in individuals at low risk of CKD is an area of ongoing research. SUMMARY Several factors contribute to estimated glomerular function decline and CKD in PLWH. Clinical risk scores for CKD may be useful to inform selection of ART in an ageing population. In people with baseline renal dysfunction, potentially nephrotoxic antiretroviral drugs should be avoided.
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Affiliation(s)
- Christine Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Shapiro AE, Bender Ignacio RA, Whitney BM, Delaney JA, Nance RM, Bamford L, Wooten D, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Webel AR, Kim HN, Van Rompaey SE, Christopoulos K, Jacobson J, Karris M, Smith D, Johnson MO, Willig A, Eron JJ, Hunt P, Moore RD, Saag MS, Mathews WC, Crane HM, Cachay ER, Kitahata MM. Factors associated with severity of COVID-19 disease in a multicenter cohort of people with HIV in the United States, March-December 2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.10.15.21265063. [PMID: 34704092 PMCID: PMC8547524 DOI: 10.1101/2021.10.15.21265063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Understanding the spectrum of SARS-CoV-2 infection and COVID-19 disease in people with HIV (PWH) is critical to provide clinical guidance and implement risk-reduction strategies. OBJECTIVE To characterize COVID-19 in PWH in the United States and identify predictors of disease severity. DESIGN Observational cohort study. SETTING Geographically diverse clinical sites in the CFAR Network of Integrated Clinical Systems (CNICS). PARTICIPANTS Adults receiving HIV care through December 31, 2020. MEASUREMENTS COVID-19 cases and severity (hospitalization, intensive care, death). RESULTS Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March-December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized and 12 died. PWH with current CD4 count <350 cells/mm 3 (aRR 2.68; 95%CI 1.93-3.71; P<.001) or lowest recorded CD4 count <200 (aRR 1.67; 95%CI 1.18-2.36; P<.005) had greater risk of hospitalization. HIV viral load suppression and antiretroviral therapy (ART) status were not associated with hospitalization, although the majority of PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared to other racial/ethnic groups (aRR 1.51; 95%CI 1.04-2.19, P=.03). Chronic kidney disease (CKD), chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher risk of hospitalization. PWH who were older, not on ART, with current CD4 <350, diabetes, and CKD were overrepresented amongst PWH who required intubation or died. LIMITATIONS Unable to compare directly to persons without HIV; underestimate of total COVID-19 cases. CONCLUSIONS PWH with CD4 <350 cells/mm 3 , low CD4/CD8 ratio, and history of CD4 <200, have a clear excess risk of severe COVID-19, after accounting for comorbidities also associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination, early treatment, and monitored closely for worsening illness.
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71
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Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, Cook HT, Fervenza FC, Gibson KL, Glassock RJ, Jayne DR, Jha V, Liew A, Liu ZH, Mejía-Vilet JM, Nester CM, Radhakrishnan J, Rave EM, Reich HN, Ronco P, Sanders JSF, Sethi S, Suzuki Y, Tang SC, Tesar V, Vivarelli M, Wetzels JF, Floege J. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021; 100:S1-S276. [PMID: 34556256 DOI: 10.1016/j.kint.2021.05.021] [Citation(s) in RCA: 787] [Impact Index Per Article: 262.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022]
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Barata R, Marques da Costa B, Navarro D, Mendes M, Silva C, Góis M, Sousa H, Nolasco F. Acute interstitial nephritis due to dolutegravir: The first case reported. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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73
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Hung A, Sinclair M, Hemmersbach-Miller M, Edmonston D, Wyatt C. Prescribing rates and characteristics of recipients of tenofovir-containing regimens before and after market entry of tenofovir alafenamide. J Manag Care Spec Pharm 2021; 26:1582-1588. [PMID: 33251997 PMCID: PMC8098116 DOI: 10.18553/jmcp.2020.26.12.1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Tenofovir alafenamide (TAF) is a new formulation of tenofovir disoproxil fumarate (TDF) that was approved in 2015. While clinical trial evidence suggests that TAF has more favorable outcomes related to kidney injury and loss of bone mineral density, TAF also leads to higher lipid levels compared with TDF. OBJECTIVES: To (a) determine prescribing rates of TDF and TAF among new recipients from 2014 to 2018 in a large academic health system and (b) compare baseline patient characteristics of those newly prescribed TDF versus TAF before and after the approval of TAF in November 2015. METHODS: Electronic health record data were used to identify new recipients of TDF or TAF from 2014 to 2018 and describe their total monthly TDF and TAF prescriptions by indication. Patient characteristics were compared among new recipients of TDF before November 2015, new recipients of TDF after November 2015, and new recipients of TAF. RESULTS: Monthly TAF prescribing rates increased to match TDF prescribing rates by April 2018 (82 vs. 88 prescriptions per month). TAF recipients and new recipients of TDF before November 2015 had similar racial distributions; both of these groups were more likely to be Black compared with new recipients of TDF after November 2015 (55% and 53% vs. 37%; P < 0.0001). TAF recipients also tended to have more comorbidities, including chronic kidney disease (7% vs. 2% and 2%; P < 0.0001), hepatitis C virus (8% vs. 5% and 3%; P < 0.0001), diabetes (13% vs. 5% and 6%; P < 0.0001), hypertension (27% vs. 13% and 13%; P < 0.0001), coronary artery disease (5% vs. 3% and 2%; P < 0.0001), hyperlipidemia (21% vs. 6% and 7%; P < 0.0001), and congestive heart failure (3% vs. 1% and 1%; P < 0.0001), compared with both new recipients of TDF before and after November 2015. CONCLUSIONS: TAF prescribing rates grew substantially in the 2.5 years after FDA approval. TAF is being prescribed more often than TDF in patients with chronic kidney disease and in patients with cardiovascular disease, suggesting that prescribers may be prioritizing the kidney safety profile over the effect on lipids. DISCLOSURES: This work was supported by the Duke Clinical Research Institute Executive Director's Pathway for Supplemental Funding. The research team received additional support from the National Institute of Diabetes, Digestive, and Kidney Disease R01DK112258 and P01DK056492 (CW) and from the National Institute of Allergy and Infectious Diseases 5T32AI100851 (MHM). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Hung reports past employment by Blue Cross Blue Shield Association and CVS Health and a grant from Pharmaceutical Research and Manufacturers of America (PhRMA), unrelated to this work. The other authors have nothing to disclose. This work was accepted as a poster presentation for the AMCP Nexus 2020 Virtual, October 19-23, 2020.
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Affiliation(s)
- Anna Hung
- Duke Clinical Research Institute and Department of Population Health Sciences, Duke University, Durham, NC
| | - Matthew Sinclair
- Duke Clinical Research Institute and Department of Medicine, Division of Nephrology, Duke University, Durham, NC
| | - Marion Hemmersbach-Miller
- Duke Clinical Research Institute and Duke Division of Infectious Diseases, Duke University, Durham, NC
| | - Daniel Edmonston
- Duke Clinical Research Institute and Department of Medicine, Division of Nephrology, Duke University, Durham, NC
| | - Christina Wyatt
- Duke Clinical Research Institute and Department of Medicine, Division of Nephrology, Duke University, Durham, NC
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Hung RK, Santana-Suarez B, Binns-Roemer E, Campbell L, Bramham K, Hamzah L, Fox J, Burns JE, Clarke A, Vincent R, Jones R, Price DA, Onyango D, Harber M, Hilton R, Booth JW, Sabin CA, Winkler CA, Post FA. The epidemiology of kidney disease in people of African ancestry with HIV in the UK. EClinicalMedicine 2021; 38:101006. [PMID: 34286237 PMCID: PMC8273351 DOI: 10.1016/j.eclinm.2021.101006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a leading cause of morbidity and mortality globally. The risk of CKD is increased in people of African ancestry and with Human Immunodeficiency Virus (HIV) infection. METHODS We conducted a cross-sectional study investigating the relationship between region of ancestry (East, Central, South or West Africa) and kidney disease in people of sub-Saharan African ancestry with HIV in the UK between May 2018 and February 2020. The primary outcome was renal impairment (estimated glomerular filtration rate [eGFR] of <60 mL/min/1.73 m2). Secondary outcomes were stage 5 CKD (eGFR <15 ml/min/1.73 m2, on dialysis for over 3 months or who had received a kidney transplant), proteinuria (urine protein/creatinine ratio >50 mg/mmol), and biopsy-confirmed HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS) or arterionephrosclerosis. Multivariable robust Poisson regression estimated the effect of region of African ancestry on kidney disease outcomes. FINDINGS Of the 2468 participants (mean age 48.1 [SD 9.8] years, 62% female), 193 had renal impairment, 87 stage 5 CKD, 126 proteinuria, and 43 HIVAN/FSGS or arterionephrosclerosis. After adjusting for demographic characteristics, HIV and several CKD risk factors and with East African ancestry as referent, West African ancestry was associated with renal impairment (prevalence ratio [PR] 2.06 [95% CI 1.40-3.04]) and stage 5 CKD (PR 2.23 [1.23-4.04]), but not with proteinuria (PR 1.27 [0.78-2.05]). West African ancestry (as compared to East/South African ancestry) was also strongly associated with a diagnosis of HIVAN/FSGS or arterionephrosclerosis on kidney biopsy (PR 6.44 [2.42-17.14]). INTERPRETATION Our results indicate that people of West African ancestry with HIV are at increased risk of kidney disease. Although we cannot rule out the possibility of residual confounding, geographical region of origin appears to be a strong independent risk factor for CKD as the association did not appear to be explained by several demographic, HIV or renal risk factors.
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Affiliation(s)
- Rachel K.Y. Hung
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
| | - Beatriz Santana-Suarez
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
| | - Elizabeth Binns-Roemer
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA
| | - Lucy Campbell
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
| | - Kate Bramham
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Hamzah
- St George's Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - James E. Burns
- University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Brighton and Sussex University Hospital NHS Trust, Brighton, UK
- Brighton and Sussex Medical School Department of Infectious Disease, Brighton, UK
| | - Rachel Vincent
- North Middlesex University Hospital NHS Trust, London, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Trust, London, UK
| | | | | | - Mark Harber
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | - Rachel Hilton
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | | | | | - Cheryl A. Winkler
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA
| | - Frank A. Post
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - GEN-AFRICA study group
- King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA
- King's College Hospital NHS Foundation Trust, London, UK
- St George's Hospital NHS Foundation Trust, London, UK
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
- University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
- Brighton and Sussex University Hospital NHS Trust, Brighton, UK
- Brighton and Sussex Medical School Department of Infectious Disease, Brighton, UK
- North Middlesex University Hospital NHS Trust, London, UK
- Chelsea and Westminster Hospital NHS Trust, London, UK
- The Newcastle Upon Tyne Hospitals, Newcastle, UK
- Africa Advocacy Foundation, UK
- Royal Free London Hospital NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
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75
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Muller E, Botha FCJ, Barday ZA, Manning K, Chin-Hong P, Stock P. Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies. Transplantation 2021; 105:1492-1501. [PMID: 33044431 PMCID: PMC8026768 DOI: 10.1097/tp.0000000000003485] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-positive patients had been successfully transplanted for the last 15 y and the donor pool had successfully been expanded to also include HIV-positive donors. METHODS We aimed to evaluate the effectiveness of transplantation in HIV-positive patients and highlight some of the important issues reported in the literature. We pooled clinical data from different cohorts to show some of the common issues encountered in HIV-positive transplantation. Furthermore, we searched MEDLINE via PubMed, EMBASE, Cochrane CENTRAL to create a comprehensive table for current evidence for different issues currently encountered when transplanting HIV-positive patients. RESULTS We included data from 19 cohort studies and reported on outcomes of the current HIV-positive transplant programs. We made recommendations based on personal experience as well as the experience reported in the literature regarding rejection, opportunistic infection, and HIV-associated nephropathy. Opportunistic infections and malignancies are not a major problem for this population group. CONCLUSIONS HIV-positive patients encounter very specific issues after transplantation, specifically related to drug interactions and higher rejection rates. When utilizing HIV-positive donors, the recurrence of HIV-associated nephropathy in the graft kidney is an issue which can be important. Despite some issues with high rejection rates, HIV-positive patients have similar results to HIV-negative patients posttransplantation.
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Affiliation(s)
- Elmi Muller
- Division of General Surgery, Department of Surgery, University of Cape Town, South Africa
| | | | | | - Kathryn Manning
- Division of General Surgery, Department of Surgery, University of Cape Town, South Africa
| | - Peter Chin-Hong
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, USA
| | - Peter Stock
- Department of Surgery, University of California San Francisco, USA
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76
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Le XQ, Liu DP, Chen J, Gong ZY, Xun JN, Wang JR, Sun JJ, Steinhart C, Liu L, Shen YZ, Qi TK, Wang ZY, Zhang X, Tang Y, Song W, Lu HZ, Zhang RF. Urinary biomarkers of early renal injury in antiretroviral-naïve HIV-positive persons in Shanghai, China: comparison with the general population. HIV Med 2021; 22:750-758. [PMID: 34114323 PMCID: PMC8453740 DOI: 10.1111/hiv.13123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
Objectives People living with HIV (PLWH) have a high risk of kidney injury. Measurement of serum creatinine, along with proteinuria, is not sensitive to detect early kidney injury. Here, we investigated novel urinary biomarkers of early renal injury in PLWH. Methods We performed a cross‐sectional study of 166 antiretroviral‐naïve PLWH and 99 HIV‐negative persons who all had an estimated glomerular filtration rate > 90 mL/min/1.73 m2. We compared the levels of seven urinary biomarkers between the two groups using the propensity score matching (PSM) approach and explored the risk factors associated with elevated urinary biomarkers in PLWH. Results Eighty‐three pairs were successfully matched based on PSM. Compared with the HIV‐negative group, the HIV‐positive group had higher ratios of N‐acetyl‐β‐D‐glucosaminidase (NAG) to urine creatinine (UCr), alpha1‐microglobulin (α1‐M) to UCr, kidney injury marker‐1 (KIM‐1) to UCr, neutrophil gelatinase‐associated lipocalin to UCr, and epidermal growth factor to UCr, whereas the Tamm–Horsfall protein to UCr ratio and the abnormal albumin to UCr ratio were not significantly different. Positive correlations were observed between HIV RNA level and NAG: UCr (rs = 0.32; P < 0.001) and α1‐M:UCr (rs = 0.24; P = 0.002) ratios, and negative correlations were observed between CD4 cell count and NAG:UCr (rs = –0.34; P < 0.001), KIM‐1:UCr (rs = –0.16; P = 0.042) and α1‐M:UCr (rs = –0.36; P < 0.001) ratios. In multivariate linear regression analyses, older age, lower total cholesterol and higher HIV RNA were independently associated with higher NAG:UCr; older age, lower total cholesterol and lower CD4 cell count were independently associated with higher α1‐M:UCr. Conclusions In comparioson with HIV‐negative participants, PLWH were more likely to have tubular injury. Early antiretroviral treatment might mitigate the development of kidney injury.
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Affiliation(s)
- X Q Le
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - D P Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - J Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Z Y Gong
- School of Clinical Medicine, Jiamusi University, Jamusi, China
| | - J N Xun
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - J R Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - J J Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - C Steinhart
- CAN Community Health, Sarasota, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
| | - L Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Y Z Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - T K Qi
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Z Y Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - X Zhang
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Tang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - W Song
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - H Z Lu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - R F Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Garza Tovar OA, Pérez AAM, Pérez MEG, Robledo IU, Galarza FFG, Márquez FCL. Serum electrolytes and renal alterations in HIV-seropositive Mexican subjects. Medicine (Baltimore) 2021; 100:e26016. [PMID: 34011103 PMCID: PMC8137016 DOI: 10.1097/md.0000000000026016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/29/2021] [Indexed: 01/05/2023] Open
Abstract
To examine potential risk factors associated with biochemical alterations in renal function in a population diagnosed with HIV/AIDS undergoing antiretroviral treatment.This is an observational, transversal, and relational design study that included 179 HIV-seropositive subjects. Glucose serum, cholesterol, triglycerides, total proteins, albumin, creatine, urea, blood urea nitrogen (BUN), and electrolytes levels were determined for each individual. Renal function was evaluated through the glomerular filtration rate (GFR), using the CKD-EPI equation. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. Univariate model significant variables, with a 95% confidence interval (CI), were included in a multivariate logistic regression analysis.CKD prevalence in patients was 7.3%, with comorbidities of 7.8% for type 2 diabetes mellitus, 7.3% for arterial hypertension, and 35.2% for dyslipidemia. Additionally, both hypernatremia and hypophosphatemia were detected in 57% (n = 102) of the patients. Multivariate logistic regression suggested that CD4+ T cell count < 200 (P = .02; OR 0.2; CI 95% 0.08-0.8) was associated to hyponatremia; similarly, detectable viral load was associated to hypokalemia (P = .02; OR 5.1; CI 95% 1.2-21.3), hypocalcemia (P = .01; OR 4.1; CI 95% 1.3-12.3), and hypermagnesemia (OR 3.9; CI 95% 1.1-13.6). Patient age was associated to both hypophosphatemia (P = .01; OR 2.4; CI 95% 1.1-5.0) and hypermagnesemia (P = .01; OR 2.8; IC 95% 1.1-7.0), and high creatinine levels were associated to nucleoside reverse transcriptase inhibitor treatment (P = .001; OR 42.5; CI 95% 2.2-806.9). Lastly, high BUN levels were associated to age (P = .03; OR 3.8; CI 95% 1.0-14.4), while GFR 60 to 89 mL/min/1.73 m2 was associated to dyslipidemia (P = .02; OR 2.2; CI 95% 1.1-4.5).CD4+ T cell and viral load were the main factors associated with renal biochemical alterations.
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Affiliation(s)
- Oscar Antonio Garza Tovar
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - Alberto Alejandro Miranda Pérez
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - María Elena Gutiérrez Pérez
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - Ivonne Urraza Robledo
- High Specialty Medical Unit (UMAE) # 71, Mexican Social Security Institute, Torreón, Coahuila, México
| | - Faviel F. González Galarza
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
| | - Francisco Carlos López Márquez
- Departamento de Inmunobiología Molecular, Centro de Investigación Biomédica, Facultad de Medicina Universidad Autónoma de Coahuila
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78
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Adedeji TA, Adebisi SA, Adedeji NO, Jeje OA, Owolabi RS. Renal Phosphate Handling in Antiretroviral-naive HIV-Infected Patients. Infect Disord Drug Targets 2021; 21:202-210. [PMID: 32634086 DOI: 10.2174/1871526520666200707115259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection impairs renal function, thereby affecting renal phosphate metabolism. OBJECTIVES We prospectively estimated the prevalence of phosphate abnormalities (mild, moderate to life-threatening hypophosphataemia, and hyperphosphataemia) before initiating antiretroviral therapy (ART). METHODS A cross-sectional analysis was performed on 170 consecutive newly diagnosed ARTnaive, HIV-infected patients attending our HIV/AIDS clinics over a period of one year. Fifty (50) screened HIV-negative blood donors were used for comparison (controls). Blood and urine were collected simultaneously for phosphate and creatinine assay to estimate fractional phosphate excretion (FEPi %) and glomerular filtration rate (eGFR). RESULTS eGFR showed significant difference between patients' and controls' medians (47.89ml/ min/1.73m2 versus 60ml/min/1.73m2, p <0.001); which denotes a moderate chronic kidney disease in the patients. Of the 170 patients, 78 (45.9%) had normal plasma phosphate (0.6-1.4 mmol/L); 85 (50%) had hyperphosphataemia. Grades 1, 2 and 3 hypophosphataemia was observed in 3 (1.8%), 3 (1.8%), and 1(0.5%) patient(s) respectively. None had grade 4 hypophosphataemia. Overall, the patients had significantly higher median of plasma phosphate than the controls, 1.4 mmol/L (IQR: 1.0 - 2.2) versus 1.1 mmol/L (IQR: 0.3 - 1.6), p <0.001, implying hyperphosphataemia in the patients; significantly lower median urine phosphate than the controls, 1.5 mmol/L (IQR: 0.7 -2.1) versus 8.4 mmol/L (IQR: 3.4 - 16), p <0.001), justifying the hyperphosphataemia is from phosphate retention; but a non-significantly lower median FEPi% than the controls, 0.96% (IQR: 0.3 -2.2) versus 1.4% (IQR: 1.2 -1.6), p > 0.05. Predictors of FEPi% were age (Odds ratio, OR 0.9, p = 0.009); weight (OR 2.0, p < 0.001); CD4+ cells count predicted urine phosphate among males (p = 0.029). CONCLUSION HIV infection likely induces renal insufficiency with reduced renal phosphate clearance. Thus, hyperphosphataemia is highly prevalent, and there is mild to moderate hypophosphataemia but its life-threatening form (grade 4) is rare among ART-naive HIV patients.
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Affiliation(s)
| | | | - Nife Olamide Adedeji
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusola Akanni Jeje
- Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Rotimi Samuel Owolabi
- Department of Medicine (HIV Unit), University of Abuja Teaching Hospital, Abuja, Nigeria
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Chen A, Xu J, Lai H, D'Agati VD, Guan TJ, Badal S, Liles J, He JC, Lee K. Inhibition of apoptosis signal-regulating kinase 1 mitigates the pathogenesis of human immunodeficiency virus-associated nephropathy. Nephrol Dial Transplant 2021; 36:430-441. [PMID: 33097961 DOI: 10.1093/ndt/gfaa198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common cause of morbidity and mortality in human immunodeficiency virus (HIV)-positive individuals. Among the HIV-related kidney diseases, HIV-associated nephropathy (HIVAN) is a rapidly progressive renal disease characterized by collapsing focal glomerulosclerosis (GS), microcystic tubular dilation, interstitial inflammation and fibrosis. Although the incidence of end-stage renal disease due to HIVAN has dramatically decreased with the widespread use of antiretroviral therapy, the prevalence of CKD continues to increase in HIV-positive individuals. Recent studies have highlighted the role of apoptosis signal-regulating kinase 1 (ASK1) in driving kidney disease progression through the activation of p38 mitogen-activated protein kinase and c-Jun N-terminal kinase and selective ASK-1 inhibitor GS-444217 was recently shown to reduce kidney injury and disease progression in various experimental models. Therefore we examined the efficacy of ASK1 antagonism by GS-444217 in the attenuation of HIVAN in Tg26 mice. METHODS GS-444217-supplemented rodent chow was administered in Tg26 mice at 4 weeks of age when mild GS and proteinuria were already established. After 6 weeks of treatment, the kidney function assessment and histological analyses were performed and compared between age- and gender-matched control Tg26 and GS-444217-treated Tg26 mice. RESULTS GS-444217 attenuated the development of GS, podocyte loss, tubular injury, interstitial inflammation and renal fibrosis in Tg26 mice. These improvements were accompanied by a marked reduction in albuminuria and improved renal function. Taken together, GS-4442217 attenuated the full spectrum of HIVAN pathology in Tg26 mice. CONCLUSIONS ASK1 signaling cascade is central to the development of HIVAN in Tg26 mice. Our results suggest that the select inhibition of ASK1 could be a potential adjunctive therapy for the treatment of HIVAN.
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Affiliation(s)
- Anqun Chen
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Nephrology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Jin Xu
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Han Lai
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Nephrology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Tian-Jun Guan
- Division of Nephrology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | | | - John Liles
- Gilead Sciences, Inc., Foster City, CA, USA
| | - John C He
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Kidney Center at James J. Peters VA Medical Center, Bronx, NY, USA
| | - Kyung Lee
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hsu R, Brunet L, Fusco J, Beyer A, Prajapati G, Wyatt C, Wohlfeiler M, Fusco G. Risk of chronic kidney disease in people living with HIV by tenofovir disoproxil fumarate (TDF) use and baseline D:A:D chronic kidney disease risk score. HIV Med 2021; 22:325-333. [PMID: 33247876 PMCID: PMC8246783 DOI: 10.1111/hiv.13019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the risk of chronic kidney disease (CKD) associated with tenofovir disoproxil fumarate (TDF) use by baseline D:A:D CKD risk score. METHODS Adult antiretroviral therapy (ART)-naïve people living with HIV (PLWH) initiating treatment, with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 , were identified in the OPERA cohort. CKD was defined as two or more consecutive eGFR < 60 mL/min/1.73 m2 , > 90 days apart. Associations between TDF use, baseline D:A:D CKD risk and incident CKD were assessed with incidence rates (IRs; Poisson regression) and adjusted pooled logistic regression. The impact of pharmacoenhancers on the observed association between TDF and CKD was also evaluated. RESULTS Of 9802 PLWH included, 6222 initiated TDF and 3580 did not (76% and 79% low D:A:D CKD risk, respectively). Overall, 125 CKD events occurred over 24 382 person-years of follow-up. Within strata of D:A:D CKD risk score, IRs were similar across TDF exposure, with high baseline CKD risk associated with highest incidence. Compared with the low-risk group without TDF, there was no statistical difference in odds of incident CKD in the low-risk group with TDF (adjusted odds ratio = 0.55, 95% confidence interval: 0.19-1.54). Odds of incident CKD did not differ statistically significantly by pharmacoenhancer exposure, with or without TDF. CONCLUSIONS In this large cohort of ART-naïve PLWH, incident CKD following ART initiation was infrequent and strongly associated with baseline CKD risk. TDF-containing regimens did not increase the odds of CKD in those with a low baseline D:A:D CKD risk, the largest group of ART-naïve PLWH, and may remain a viable treatment option in appropriate settings.
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Affiliation(s)
- R Hsu
- NYU Langone Health CenterNew YorkNYUSA
- AIDS Healthcare FoundationNew YorkNYUSA
| | | | | | - A Beyer
- Merck & Co., Inc.KenilworthNJUSA
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Yusuf AA, Musa BM, Galadanci NA, Babashani M, Mohammed AZ, Ingles DJ, Fogo AB, Wester CW, Aliyu MH. HIV-associated nephropathy: Protocol and rationale for an exploratory genotype-phenotype study in a sub-Saharan African population. PLoS One 2021; 16:e0249567. [PMID: 33822824 PMCID: PMC8023480 DOI: 10.1371/journal.pone.0249567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/05/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND HIV-positive persons of African descent are disproportionately affected by chronic kidney disease (CKD). Deterioration to end-stage kidney disease (ESKD) also occurs in this population at a higher frequency. There remains a lot to learn about the genetic susceptibility to CKD in HIV positive patients, and the pathophysiology of progression to ESKD. OBJECTIVES We will conduct an exploratory genotype-phenotype study in HIV-positive persons with CKD in Aminu Kano Teaching Hospital, Nigeria, to determine blood-based differential gene expression biomarkers in different kidney risk groups according to the KDIGO 2012 criteria. METHODS We will consecutively screen 150 HIV-positive adults (≥18 years of age) attending the HIV clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, for CKD based on proteinuria and elevation of estimated glomerular filtration rate. Among these, two separate groups of 16 eligible participants each (n = 32) will be selected in the four (4) KDIGO 2012 kidney risk categories. The groups will be matched for age, sex, viral suppression level and antiretroviral (ARV) regimen. In the first group (n = 16), we will determine differential gene expression markers in peripheral blood mononuclear cells using mRNA-sequencing (RNA-Seq). We will validate the differential expression markers in the second group (n = 16) using reverse transcription quantitative polymerase chain reaction (RT-qPCR). Using a systems-based approach, we will construct, visualize and analyze gene-gene interaction networks to determine the potential biological roles of identified differential expression markers based on published literature and publicly available databases. RESULTS Our exploratory study will provide valuable information on the potential roles of differential expression biomarkers in the pathophysiology of HIV-associated kidney disease by identifying novel biomarkers in different risk categories of CKD in a sub-Saharan African population. The results of this study will provide the basis for population-based genome-wide association studies to guide future personalized medicine approaches. CONCLUSION Validated biomarkers can be potential targets for the development of stage-specific therapeutic interventions, an essential paradigm in precision medicine.
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Affiliation(s)
- Aminu Abba Yusuf
- Department of Haematology and Blood Transfusion, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Baba Maiyaki Musa
- Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
- Africa Center of Excellence for Population Health and Policy
| | - Najibah Aliyu Galadanci
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Musa Babashani
- Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aminu Zakari Mohammed
- Department of Histopathology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Donna J. Ingles
- Vanderbilt Institute of Global Health (VIGH), Nashville, Tennessee, United States of America
| | - Agnes B. Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - C. William Wester
- Vanderbilt Institute of Global Health (VIGH), Nashville, Tennessee, United States of America
| | - Muktar Hassan Aliyu
- Vanderbilt Institute of Global Health (VIGH), Nashville, Tennessee, United States of America
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Brief Report: Subclinical Kidney Dysfunction in HIV-Infected Children: A Cross-Sectional Study. J Acquir Immune Defic Syndr 2021; 85:470-474. [PMID: 33136747 DOI: 10.1097/qai.0000000000002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most of the kidney dysfunction in HIV-positive children receiving antiretroviral therapy (ART) is attributed to tenofovir. There is a paucity of data on kidney dysfunction in tenofovir-naive children. The primary objective was to know the point prevalence of albuminuria and β2-microglobulinuria in HIV-infected children aged 3-18 years receiving ART. Albuminuria and β2-microglobulinuria were used as surrogates for glomerular and tubular dysfunction, respectively. The secondary objective was to determine their predictors. DESIGN Cross-sectional study-design. METHODS One hundred consecutive HIV-positive children (3-18 years) on ART were included. Spot urine sample was analyzed for urinary creatinine, total protein, microalbumin, and β2-microglobulin. Albuminuria was defined as albumin to creatinine ratio of >30 mg/g; proteinuria as urine dipstick ≥trace or spot urine protein to creatinine ratio (uPCR) of ≥0.2. β2-microglobulinuria was defined as β2-microglobulin levels of >350 µg/L. RESULTS There were 71 boys and 29 girls. Most of the children had WHO clinical stage I and were getting zidovudine-based regimen. Only 7 children were getting tenofovir. estimated Glomerular Filtration Rate and serum creatinine were normal in all children. Approximately half (48%) had renal dysfunction in the form of glomerular dysfunction (26%), tubular dysfunction (27%), or both (5%). Age at diagnosis was significantly associated with β2-microglobulinuria (P = 0.044). None of the selected variables were associated with albuminuria. CONCLUSIONS HIV-associated glomerular and tubular dysfunction is common in children receiving ART other than tenofovir. The standard guidelines should consider including routine urinary biomarker monitoring in children on ART.
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Feng J, Bao L, Wang X, Li H, Chen Y, Xiao W, Li Z, Xie L, Lu W, Jiang H, Lee K, He JC. Low expression of HIV genes in podocytes accelerates the progression of diabetic kidney disease in mice. Kidney Int 2021; 99:914-925. [PMID: 33359498 PMCID: PMC8006538 DOI: 10.1016/j.kint.2020.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/11/2020] [Accepted: 12/07/2020] [Indexed: 01/22/2023]
Abstract
With the widespread use combination antiretroviral therapy, there has been a dramatic decrease in HIV-associated nephropathy. However, although the patients living with HIV have low or undetectable viral load, the prevalence of chronic kidney disease (CKD) in this population remains high. Additionally, improved survival is associated with aging-related comorbidities such as diabetes and cardiovascular disease. A faster progression of CKD is associated with concurrent HIV infection and diabetes than with HIV infection or diabetes alone. To explore the potential pathogenic mechanisms that synergistically drive CKD progression by diabetes and HIV infection, we generated a new mouse model with a relatively low expression of HIV-1 proviral genes specifically in podocytes (pod-HIV mice) to better mimic the setting of kidney injury in patients living with HIV. While no apparent kidney phenotypes were observed at baseline in pod-HIV mice, the induction of mild diabetic kidney disease with streptozotocin led to significant worsening of albuminuria, glomerular injury, podocyte loss, and kidney dysfunction as compared to the mice with diabetes alone. Mechanistically, diabetes and HIV-1 synergistically increased the glomerular expression of microRNA-34a (miR-34a), thereby reducing the expression of Sirtuin-1 (SIRT1) deacetylase. These changes were also associated with increased acetylation and activation of p53 and p65 NF-κB and with enhanced expression of senescence and inflammatory markers. The treatment of diabetic pod-HIV mice with the specific Sirtuin-1 agonist BF175 significantly attenuated albuminuria and glomerulopathy. Thus, our study highlights the reduction in Sirtuin-1 as a major basis of CKD progression in diabetic patients living with HIV and suggests Sirtuin-1 agonists as a potential therapy.
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Affiliation(s)
- Jie Feng
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Bao
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Xuan Wang
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Huilin Li
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yuqiang Chen
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Wenzhen Xiao
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zhengzhe Li
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Liyi Xie
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wanhong Lu
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hongli Jiang
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kyung Lee
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - John Cijiang He
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA; Renal Section, James J. Peters VAMC, Bronx, New York, USA.
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Araújo AN, Cunha M, Marques T, Bugalho MJGM. Multifactorial diabetes insipidus during pregnancy: a challenging diagnosis. BMJ Case Rep 2021; 14:14/3/e238410. [PMID: 33722910 PMCID: PMC7959218 DOI: 10.1136/bcr-2020-238410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Diabetes insipidus (DI) is characterised by thirst and polydipsia with hypotonic polyuria. Several forms exist, namely, central or pituitary, nephrogenic and gestational and must be differentiated for adequate treatment. We describe the case of a 41-year-old woman chronically infected with HIV who had been recently medicated with a tenofovir-based antiretroviral treatment and who, at 22 weeks of pregnancy, presented with transient gestational DI. Obstetric ultrasound revealed oligohydramnios and foetal growth restriction that did not improve despite serum sodium correction. The severity of the case suggested the presence of an underlying disorder and elevated copeptin levels indicated that an underlying subclinical form of nephrogenic DI, possibly induced by HIV-related nephropathy or tenofovir use, was present and rendered clinically overt during pregnancy.
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Affiliation(s)
- Alexandra Novais Araújo
- Hospital de Santa Maria, Serviço de Endocrinologia, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | - Maria Cunha
- Hospital de Santa Maria, Serviço de Infecciologia, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | - Tiago Marques
- Hospital de Santa Maria, Serviço de Infecciologia, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | - Maria João Guerreiro Martins Bugalho
- Hospital de Santa Maria, Serviço de Endocrinologia, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal .,Faculdade de Medicina Lisboa, Lisboa, Portugal
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85
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Hughes K, Chang J, Stadtler H, Wyatt C, Klotman M, Blasi M. HIV-1 infection of the kidney: mechanisms and implications. AIDS 2021; 35:359-367. [PMID: 33229896 PMCID: PMC7855797 DOI: 10.1097/qad.0000000000002753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
People living with HIV are at higher risk for acute and chronic kidney disease compared with uninfected individuals. Kidney disease in this population is multifactorial, with several contributors including HIV infection of kidney cells, chronic inflammation, genetic predisposition, aging, comorbidities, and coinfections. In this review, we provide a summary of recent advancements in the understanding of the mechanisms and implications of HIV infection and kidney disease, with particular focus on the role of direct HIV infection of renal cells.
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Affiliation(s)
- Kelly Hughes
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jerry Chang
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Hannah Stadtler
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - Mary Klotman
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Maria Blasi
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
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Fiseha T, Ahmed E, Chalie S, Gebreweld A. Prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to a hospital in Northeast Ethiopia. PLoS One 2021; 16:e0246509. [PMID: 33539455 PMCID: PMC7861367 DOI: 10.1371/journal.pone.0246509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is increasingly common in hospitalized patients and is associated with increased risk for in-hospital morbidity and mortality. However, data regarding the prevalence of CKD in the African hospitalized patient population are limited. We therefore examined the prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to the internal medicine wards of a hospital in Northeast Ethiopia. Methods A cross-sectional study was conducted from January 1 to April 30, 2020 at the inpatient settings of Dessie referral hospital. Data on demographics and medical history were obtained, and serum creatinine and albuminuria were analyzed. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as impaired eGFR (<60 ml/min/1.73m2) and/or albuminuria. Univariate and multivariable analysis were conducted to determine factors associated with impaired eGFR and albuminuria. Results A total of 369 patients were included in this study. The prevalence of impaired eGFR was 19.0% (95%CI: 15.2%–23.2%) and albuminuria was 30.9% (95%CI: 26.3%–35.7%). Overall, 33.9% (95%CI: 29.2%–38.9%) of the patients had some degree of CKD, but only 21.6% (95%CI: 15.1%–29.4%) were aware of their renal disease. In multivariable analysis, older age, a family history of kidney disease, diabetes, hypertension and HIV were independently associated with both impaired eGFR and albuminuria while male gender was independently associated with only albuminuria. Conclusions CKD is common in adult patients admitted to the internal medicine wards, but only few patients are aware of their condition. These findings highlight the need for feasible approaches to timely identify kidney disease and raise awareness on the importance of detection and early intervention in the inpatient settings.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Ermiyas Ahmed
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Semagn Chalie
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Beng H, Rakhmanina N, Moudgil A, Tuchman S, Ahn SY, Griffith C, Mims MM, Ray PE. HIV-Associated CKDs in Children and Adolescents. Kidney Int Rep 2020; 5:2292-2300. [PMID: 33305123 PMCID: PMC7710839 DOI: 10.1016/j.ekir.2020.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Limited information is available describing the current prevalence of proteinuria and HIV-associated CKDs (HIV-CKDs) in children and adolescents living with HIV and receiving antiretroviral therapy in the United States. METHODS To address this issue, we performed a retrospective study of children and adolescents living with HIV who received medical care at Children's National Hospital in Washington, DC, between January 2012 and July 2019. Demographic data, clinical parameters (mode of HIV transmission, viral loads, CD4 cell counts, serum creatinine, glomerular filtration rate [GFR], plasma lipid levels, proteinuria, blood pressure, renal biopsies), and medical treatments, all done as a standard of clinical care, were collected and analyzed. RESULTS The majority of the 192 patients enrolled were of African descent (88%) and acquired HIV through vertical transmission (97%). The prevalence of all HIV-CKDs was 6%. Of these patients, 39% had intermittent or persistent proteinuria, and 7% percent had proteinuria with a mild decline in GFR (60-80 ml/min per 1.73 m2), and 6% had a mild decline in GFR without proteinuria. Documented hypertension was present in 6% of the patients, mainly in association with HIV-CKD. Patients with persistent proteinuria (3%) and biopsy-proven HIV-CKD had a slow but constant progression of their renal diseases. CONCLUSIONS The prevalence of persistent proteinuria and HIV-CKD was lower than that reported in previous studies conducted in the United States. However, intermittent proteinuria, mild reductions in GFR, and progression of established HIV-CKD were common findings in this group of patients with predominantly vertically acquired HIV who were receiving antiretroviral therapy.
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Affiliation(s)
- Hostensia Beng
- Division of Nephrology, Children’s National Hospital, Washington District of Columbia, USA
| | - Natella Rakhmanina
- Division of Infectious Diseases, Children’s National Hospital, Washington District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
- Elizabeth Glaser Pediatrics AIDS Foundation, Washington, District of Columbia, USA
| | - Asha Moudgil
- Division of Nephrology, Children’s National Hospital, Washington District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Shamir Tuchman
- Division of Nephrology, Children’s National Hospital, Washington District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Sun-Young Ahn
- Division of Nephrology, Children’s National Hospital, Washington District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Caleb Griffith
- Division of Infectious Diseases, Children’s National Hospital, Washington District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Marva Moxey Mims
- Division of Nephrology, Children’s National Hospital, Washington District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Patricio E. Ray
- Division of Nephrology, Children’s National Hospital, Washington District of Columbia, USA
- Child Health Research Center, Department of Pediatrics, University of Virginia, School of Medicine, Charlottesville, Virginia, USA
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Poda A, Kabore NF, Malateste K, De Rekeneire N, Semde A, Bikinga Y, Patassi A, Chenal H, Messou E, Dabis F, Ekouevi DK, Jaquet A, Cournil A. Validation of the D:A:D chronic kidney disease risk score in people living with HIV: the IeDEA West Africa Cohort Collaboration. HIV Med 2020; 22:113-121. [PMID: 33145918 DOI: 10.1111/hiv.12982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/01/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES A risk score for long-term prediction of chronic kidney disease (CKD) in people living with HIV (PLHIV) has been developed using data from the D:A:D cohort. We assessed the performance of the D:A:D risk score in a cohort of PLHIV in West Africa. METHODS Data from PLHIV starting antiretroviral treatment in four clinics in Burkina Faso, Côte d'Ivoire and Togo participating in the IeDEA West Africa collaboration were analysed. CKD was defined as two consecutive estimated glomerular filtration rates (eGFRs) of ≤ 60 mL/min/1.73 m2 . The D:A:D score (short version) was calculated using age, gender, nadir CD4 and baseline eGFR and was categorized into low, medium, and high-risk groups. RESULTS In 14 930 participants (70% female, median age = 38 years; median nadir CD4 count = 183 cells/µL) followed for a median duration of 5.7 years, 660 (4.4%) progressed to CKD, with an incidence [95% confidence interval (CI)] of 7.8 (7.2-8.4) per 1000 person-years (PY). CKD incidence rates were 2.4 (2.0-2.8), 8.1 (6.8-9.6) and, 30.9 (28.0-34.1) per 1000 PY in the low-, medium- and high-risk groups, respectively. In the high-risk group, 14.7% (95% CI: 13.3; 16.3) had progressed to CKD at 5 years. Discrimination was good [C-statistics = 0.81 (0.79-0.83)]. In all, 79.4% of people who progressed to CKD were classified in the medium- to high-risk group at baseline (sensitivity) and 66.5% of people classified in the low risk group at baseline did not progress to CKD (specificity). CONCLUSIONS These findings confirm the validity of the D:A:D score in identifying individuals at risk of developing CKD who could benefit from enhanced kidney monitoring in West African HIV clinics.
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Affiliation(s)
- A Poda
- Department of Infectious Diseases, Sourô Sanou University Hospital, Bobo Dioulasso, Burkina Faso
| | - N F Kabore
- Clinical Research Department, Centre MURAZ, Bobo Dioulasso, Burkina Faso
| | - K Malateste
- Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Bordeaux University, Bordeaux, France
| | - N De Rekeneire
- Clinical Research Department, Centre MURAZ, Bobo Dioulasso, Burkina Faso
| | - A Semde
- Department of Nephrology, Sourô Sanou University Hospital, Bobo Dioulasso, Burkina Faso
| | - Y Bikinga
- Department of Nephrology, Bogodogo University Hospital, Ouagadougou, Burkina Faso
| | - A Patassi
- Department of Infectious and Tropical Diseases, Sylvanus Olympio University Hospital, Lomé, Togo
| | - H Chenal
- Centre Intégré de Recherches Biocliniques d'Abidjan (CIRBA), Abidjan, Côte d'Ivoire
| | - E Messou
- Centre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte d'Ivoire
| | - F Dabis
- Institut national de la santé et de la recherche médicale-ANRS (France REcherche Nord&Sud Sida-hiv Hépatites), Paris, France
| | - D K Ekouevi
- Public Health Department, Lomé University, Lome, Togo
| | - A Jaquet
- Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Bordeaux University, Bordeaux, France
| | - A Cournil
- Pathogenesis & Control of Chronic Infections, INSERM U1058, Montpellier University, Montpellier, France
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89
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Bookholane H, Wearne N, Surapaneni A, Ash S, Berghammer-Böhmer R, Omar A, Spies R, Grams ME. Predictors and Prognosis of HIV-Associated Nephropathy on Kidney Biopsy in South Africa. Kidney Int Rep 2020; 5:1799-1804. [PMID: 33102974 PMCID: PMC7569688 DOI: 10.1016/j.ekir.2020.06.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction South Africa has the highest prevalence of HIV in the world. The epidemiology of kidney disease among people with HIV infections is well-described in the United States. However, there are limited data coming from South Africa, particularly that involve kidney biopsies. The purpose of this study was to determine what, if any, patient factors are predictive of HIV-associated nephropathy (HIVAN) on kidney biopsy in a South African kidney biopsy cohort. Methods This study prospectively collected data of all patients infected with HIV referred to the Groote Schuur Hospital (GSH) renal unit for a kidney biopsy from 2002 to 2018. Results There were 419 patients included in the study. Mean age was 36.5 years (SD, 9.4); 219 (52.3%) were women; and all were black. Seventy-nine patients (18.9%) were on dialysis at the time of biopsy; the mean estimated glomerular filtration rate among the remainder was 41.4 ml/min per 1.73 m2 (SD, 39.2). Only 163 patients (47.1%) were known to be taking antiretroviral therapy (ART) at the time of biopsy. There were 246 (58.7%) cases of HIVAN detected, and they were comparable on age, sex, kidney function, and kidney size to those with kidney disease of other causes but were less likely to be taking ART (P < 0.001). Biopsy confirmed HIVAN was associated with mortality (adjusted hazard ratio, 1.77; 95% confidence interval [CI]: 1.07–2.91; P = 0.025), and the use of ART at biopsy was protective (adjusted hazard ratio, 0.52; 95% CI, 0.32–0.84, P = 0.008). The proportion of HIVAN on biopsy decreased and the proportion taking ART increased from 2002 to 2018 (P for trend for both < 0.001). Conclusion In summary, HIVAN was the most common etiology of kidney disease in this biopsy cohort from South Africa; however, the proportion with biopsy-proven HIVAN declined over time, perhaps in the setting of greater ART availability.
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Affiliation(s)
- Hloni Bookholane
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicola Wearne
- Division of Nephrology and Hypertension, Groote Schuur Hospital Cape Town, Kidney and Hypertension Research Unit, University of Cape Town, Cape Town South Africa.,Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Aditya Surapaneni
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samantha Ash
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Aadil Omar
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ruan Spies
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Morgan E Grams
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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90
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Tariq A, Kim H, Abbas H, Lucas GM, Atta MG. Pharmacotherapeutic options for kidney disease in HIV positive patients. Expert Opin Pharmacother 2020; 22:69-82. [PMID: 32955946 DOI: 10.1080/14656566.2020.1817383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Since the developmentof combined antiretroviral therapy (cART), HIV-associated mortality and the incidence of HIV-associated end-stage kidney disease (ESKD) has decreased. However, in the United States, an increase in non-HIV-associated kidney diseases within the HIV-positive population is expected. AREAS COVERED In this review, the authors highlight the risk factors for kidney disease within an HIV-positive population and provide the current recommendations for risk stratification and for the monitoring of its progression to chronic kidney disease (CKD), as well as, treatment. The article is based on literature searches using PubMed, Medline and SCOPUS. EXPERT OPINION The authors recommend clinicians (1) be aware of early cART initiation to prevent and treat HIV-associated kidney diseases, (2) be aware of cART side effects and discriminate those that may become more nephrotoxic than others and require dose-adjustment in the setting of eGFR ≤ 30ml/min/1.73m2, (3) follow KDIGO guidelines regarding screening and monitoring for CKD with a multidisciplinary team of health professionals, (4) manage other co-infections and comorbidities, (5) consider changing cART if drug induced toxicity is established with apparent eGFR decline of ≥ 10ml/min/1.73m2 or rising creatinine (≥0.5mg/dl) during drug-drug interactions, and (6) strongly consider kidney transplant in appropriately selected individuals with end stage kidney failure.
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Affiliation(s)
- Anam Tariq
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Hannah Kim
- Division of Pediatric Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Hashim Abbas
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
| | - Gregory M Lucas
- Division of Infectious Disease, Johns Hopkins University , Baltimore, MD, US
| | - Mohamed G Atta
- Division of Nephrology, Johns Hopkins University , Baltimore, MD, US
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91
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Ryom L, Cotter A, De Miguel R, Béguelin C, Podlekareva D, Arribas JR, Marzolini C, Mallon P, Rauch A, Kirk O, Molina JM, Guaraldi G, Winston A, Bhagani S, Cinque P, Kowalska JD, Collins S, Battegay M. 2019 update of the European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0. HIV Med 2020; 21:617-624. [PMID: 32885559 PMCID: PMC7754379 DOI: 10.1111/hiv.12878] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The European AIDS Clinical Society (EACS) Guidelines cover key aspects of HIV management with major updates every two years. GUIDELINE HIGHLIGHTS The 2019 Guidelines were extended with a new section focusing on drug-drug interactions and other prescribing issues in people living with HIV (PLWH). The recommendations for treatment-naïve PLWH were updated with four preferred regimens favouring unboosted integrase inhibitors. A two-drug regimen with dolutegravir and lamivudine, and a three-drug regimen including doravirine were also added to the recommended initial regimens. Lower thresholds for hypertension were expanded to all PLWH and for cardiovascular disease prevention, the 10-year predicted risk threshold for consideration of antiretroviral therapy (ART) modification was lowered from 20% to 10%. Frailty and obesity were added as new topics. It was specified to use urine albumin to creatinine ratio to screen for glomerular disease and urine protein to creatinine ratio for tubular diseases, and thresholds were streamlined with the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations. Hepatitis C virus (HCV) treatment recommendations were split into preferred and alternative treatment options. The algorithm for management of recently acquired HCV infection was updated and includes recommendations for early chronic infection management. Treatment of resistant tuberculosis (TB) was streamlined with the World Health Organization (WHO) recommendations, and new tables on immune reconstitution inflammatory syndrome, on when to start ART in the presence of opportunistic infections and on TB drug dosing were included. CONCLUSIONS The EACS Guidelines underwent major revisions of all sections in 2019. They are available in four different formats including a new interactive web-based version and are translated into Chinese, French, German, Japanese, Portuguese, Russian and Spanish.
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Affiliation(s)
- L Ryom
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Cotter
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - R De Miguel
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Podlekareva
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J R Arribas
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Pgm Mallon
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - A Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - O Kirk
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J M Molina
- Department of Infectious Diseases, St Louis and Lariboisière Hospitals, APHP and University of Paris, Paris, France
| | - G Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - S Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Trust, Institute of Global Health, University College London, London, UK
| | - P Cinque
- Division of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - J D Kowalska
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - M Battegay
- Division of Infectious Diseases et Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
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92
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Hughes K, Akturk G, Gnjatic S, Chen B, Klotman M, Blasi M. Proliferation of HIV-infected renal epithelial cells following virus acquisition from infected macrophages. AIDS 2020; 34:1581-1591. [PMID: 32701578 PMCID: PMC7579771 DOI: 10.1097/qad.0000000000002589] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES HIV-1 can infect and persist in different organs and tissues, resulting in the generation of multiple viral compartments and reservoirs. Increasing evidence supports the kidney as such a reservoir. Previous work demonstrated that HIV-1 infected CD4 T-cells transfer virus to renal tubule epithelial (RTE) cells through cell-to-cell contact. In addition to CD4 T cells, macrophages represent the other major target of HIV-1. Renal macrophages induce and regulate inflammatory responses and are critical to homeostatic regulation of the kidney environment. Combined with their ability to harbour virus, macrophages may also play an important role in the spread of HIV-1 infection in the kidney. DESIGN AND METHODS Multiparametric histochemistry analysis was performed on kidney biopsies from individuals with HIV-1 associated nephropathy (HIVAN). Primary monocyte-derived macrophages were infected with a GFP-expressing replication competent HIV-1. HIV-1 transfer from macrophages to RTE cells was carried out in a coculture system and evaluated by fluorescence-microscopy and flow-cytometry. Live imaging was performed to assess the fate of HIV-1 infected RTE cells over time. RESULTS We show that macrophages are abundantly present in the renal inflammatory infiltrate of individuals with HIVAN. We observed contact-dependent HIV-1 transfer from infected macrophages to both primary and immortalized renal cells. Live imaging of HIV-1 infected RTE cells revealed four different fates: proliferation, hypertrophy, latency and cell death. CONCLUSION Our study suggests that macrophages may play a role in the dissemination of HIV-1 in the kidney and that proliferation of infected renal cells may contribute to HIV-1 persistence in this compartment.
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Affiliation(s)
- Kelly Hughes
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Guray Akturk
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sacha Gnjatic
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Chen
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary Klotman
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Maria Blasi
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
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93
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Tiong M, Wilson S, Pham A, Chrysostomou A. Successful treatment of HIV-associated lupus-like glomerulonephritis with mycophenolic acid. Clin Case Rep 2020; 8:1601-1604. [PMID: 32983458 PMCID: PMC7495868 DOI: 10.1002/ccr3.2955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/12/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022] Open
Abstract
HIV-associated lupus-like glomerulonephritis is an uncommon but well-described entity. Treatment has traditionally focused on control of HIV viremia with some using adjuvant steroids. Mycophenolic acid may prove to be a novel, nonsteroid, therapy in patients with active glomerulonephritis despite control of the underlying infection.
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Affiliation(s)
- Mark Tiong
- Department of Renal MedicineAlfred HealthMelbourneVic.Australia
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVic.Australia
| | - Scott Wilson
- Department of Renal MedicineAlfred HealthMelbourneVic.Australia
- Department of MedicineMonash UniversityMelbourneVic.Australia
- Department of MedicineEpworth HealthCareMelbourneVic.Australia
| | - Alan Pham
- Department of Anatomical PathologyAlfred HealthMelbourneVic.Australia
| | - Anastasia Chrysostomou
- Department of MedicineMonash UniversityMelbourneVic.Australia
- Department of MedicineEpworth HealthCareMelbourneVic.Australia
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94
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Rituximab for Lupus-Like Membranous Nephropathy in the Setting of Well-Controlled HIV Infection. Am J Ther 2020; 28:e732-e734. [PMID: 32769387 DOI: 10.1097/mjt.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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95
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Wearne N, Okpechi I, Swanepoel C. Where are we now with kidney disease in the human immunodeficiency virus-infected individual? Nephrol Dial Transplant 2020; 35:1317-1319. [PMID: 30184170 DOI: 10.1093/ndt/gfy275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nicola Wearne
- Division of Nephrology and Hypertension, Groote Schuur Hospital, Department of Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, Department of Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| | - Ikechi Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital, Department of Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, Department of Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
| | - Charles Swanepoel
- Division of Nephrology and Hypertension, Groote Schuur Hospital, Department of Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, Department of Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
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96
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Overton ET, Kantor A, Fitch KV, Muntner P, Supparatpinyo K, Mosepele M, Mohapi L, Cardoso SW, Patil S, de Lacerda MVG, McComsey G, Aberg JA, Douglas PS, Grinspoon SK, Ribaudo H, Wyatt CM. An Evaluation of Baseline Kidney Function in the REPRIEVE Trial of Pitavastatin in Human Immunodeficiency Virus. J Infect Dis 2020; 222:S41-S51. [PMID: 32645164 PMCID: PMC7347080 DOI: 10.1093/infdis/jiaa222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic kidney disease is a common comorbid condition among persons living with human immunodeficiency virus (PWH). We characterized baseline kidney function in the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) trial cohort. METHODS REPRIEVE enrolled PWH with low to moderate cardiovascular risk based on traditional risk factors to evaluate the effect of statin therapy on cardiovascular events. We determined baseline estimated glomerular filtration rate (eGFR) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease, and Cockcroft-Gault equations, and we evaluated baseline factors associated with eGFR <90 mL/min/1.73 m2 by logistic regression. We performed Bland-Altman plots and scatterplots to assess agreement between equations. RESULTS Among 7770 participants enrolled, the median age was 50 years, 31% were female (natal sex), 43% black or African American and 15% Asian, the median body mass index (calculated as calculated as weight in kilograms divided by height in meters squared) was 25.8, and the median CD4 cell count 620/µL. The median CKD-EPI eGFR was 97 mL/min/1.73 m2, and 38% had an eGFR <90 mL/min/1.73 m2. In the adjusted model, factors associated with eGFR <90 mL/min/1.73 m2 included white race, older age, higher body mass index, high-income region of enrollment, hypertension, and tenofovir disoproxil fumarate. The CKD-EPI and Modification of Diet in Renal Disease equations demonstrated strong agreement, particularly at lower eGFR values. Overall, there was 56% concordance between the 3 equations (categories <60, 60 to <90, ≥90 mL/min), improving to 73% after accounting for individual body surface area. CONCLUSIONS REPRIEVE enrolled a diverse cohort including a substantial number of PWH with reduced kidney function. Factors associated with reduced eGFR included traditional risk factors and tenofovir disoproxil fumarate exposure. Three commonly used equations have only fair agreement, with potential implications for both clinical care and epidemiologic studies. CLINICAL TRIALS REGISTRATION NCT02344290.
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Affiliation(s)
- Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Amy Kantor
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kathleen V Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Mosepele Mosepele
- University of Botswana and Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lerato Mohapi
- Soweto Clinical Research Site, Chris Hani Baragwanath Hospital, Johannesburg, Gauteng, South Africa
| | - Sandra Wagner Cardoso
- Fiocruz Therapeutic and Prevention HIV/AIDS Clinical Trials Unit, Rio de Janeiro, Brazil
| | - Sandesh Patil
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | | | - Grace McComsey
- Division of Pediatric Infectious Diseases and Rheumatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heather Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christina M Wyatt
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, USA
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97
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Abstract
: With current antiretroviral therapy, the lifespan of newly diagnosed persons with HIV (PWH) approaches that of uninfected persons. However, metabolic abnormalities related to both the disease and the virus itself, along with comorbidities of aging, have resulted in end-organ disease and organ failure as a major cause of morbidity and mortality. Solid organ transplantation is a life-saving therapy for PWH who have organ failure, and the approval of the HIV Organ Policy Equity Act has opened and expanded opportunities for PWH to donate and receive organs. The current environment of organ transplantation for PWH will be reviewed and future directions of research and treatment will be discussed.
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98
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Schrader SY, Zeder AJ, Hilge R, Bogner JR, Seybold U. Medium-grade proteinuria is a risk factor for incident markers of chronic kidney disease. HIV Med 2020; 21:481-491. [PMID: 32558056 DOI: 10.1111/hiv.12881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Medium-grade proteinuria (100-500 mg/g creatinine) is common among people living with HIV/AIDS (PLWHA) but is often undetected or ignored. This prospective, observational cohort study examined medium-grade proteinuria as a risk factor for markers of chronic kidney disease (CKD). METHODS Quantitative urine samples were collected from 241 PLWHA without known renal disease at baseline between January 2009 and February 2011 and at follow-up 240 weeks later. Multivariate analysis was performed to assess medium-grade proteinuria as a risk factor for incident markers of CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 , albuminuria, phosphaturia). RESULTS Incident markers of CKD were identified in 33 patients (14%), of whom 24 (74%) had medium-grade proteinuria at baseline. Of these, 22 even had proteinuria of < 200 mg/g creatinine. Multivariate analysis showed an adjusted relative risk (aRR) of 2.4 for patients with baseline medium-grade proteinuria to develop signs of CKD. Age was identified as an additional independent predictor. By testing for interaction, tenofovir disoproxil fumarate (TDF)-independent proteinuria was strongly associated with incident CKD markers (aRR = 12.1). CONCLUSION Medium-grade proteinuria of 100-500 mg/g creatinine is both frequent in PLWHA and a significant risk factor for developing markers of CKD, especially in the absence of TDF. Relevant risk seems to be associated with proteinuria levels as low as 100-200 mg/g creatinine. Current guidelines recommend specific action for proteinuria exceeding 135-200 mg/g but still will miss a relevant number of PLWHA potentially at risk for CKD. An even lower cut-off to trigger nephrological work-up and potentially renoprotective interventions appears to be indicated.
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Affiliation(s)
- S Y Schrader
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany.,Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
| | - A J Zeder
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany.,Abteilung für Infektions- und Tropenmedizin, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
| | - R Hilge
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany.,Department of Nephrology, München Klinik Harlaching, München, Germany
| | - J R Bogner
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
| | - U Seybold
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
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99
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Seybold U. [Is a creatinine value and a urine stix sufficient?]. MMW Fortschr Med 2020; 162:28-32. [PMID: 32583252 DOI: 10.1007/s15006-020-0642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Ulrich Seybold
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, D-80336, München, Deutschland.
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100
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HIV protease inhibitor ritonavir induces renal fibrosis and dysfunction: role of platelet-derived TGF-β1 and intervention via antioxidant pathways. AIDS 2020; 34:989-1000. [PMID: 32167970 DOI: 10.1097/qad.0000000000002516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Chronic kidney disease (CKD) with tubular injury and fibrosis occurs in HIV infection treated with certain protease inhibitor-based antiretroviral therapies. The pathophysiology is unclear. DESIGN We hypothesized that fibrosis, mediated by platelet-derived transforming growth factor (TGF)-β1, underlies protease inhibitor-associated CKD. We induced this in mice exposed to the protease inhibitor ritonavir (RTV), and intervened with low-dose inhaled carbon monoxide (CO), activating erythroid 2-related factor (Nrf2)-associated antioxidant pathways. METHODS Wild-type C57BL/6 mice and mice deficient in platelet TGF-β1, were given RTV (10 mg/kg) or vehicle daily for 8 weeks. Select groups were exposed to CO (250 ppm) for 4 h after RTV or vehicle injection. Renal disorder, fibrosis, and TGF-β1-based and Nrf2-based signaling were examined by histology, immunofluorescence, and flow cytometry. Renal damage and dysfunction were assessed by KIM-1 and cystatin C ELISAs. Clinical correlations were sought among HIV-infected individuals. RESULTS RTV-induced glomerular and tubular injury, elevating urinary KIM-1 (P = 0.004). It enhanced TGF-β1-related signaling, accompanied by kidney fibrosis, macrophage polarization to an inflammatory phenotype, and renal dysfunction with cystatin C elevation (P = 0.008). Mice lacking TGF-β1 in platelets were partially protected from these abnormalities. CO inhibited RTV-induced fibrosis and macrophage polarization in association with upregulation of Nrf2 and heme oxygenase-1 (HO-1). Clinically, HIV infection correlated with elevated cystatin C levels in untreated women (n = 17) vs. age-matched controls (n = 19; P = 0.014). RTV-treated HIV+ women had further increases in cystatin C (n = 20; P = 0.05), with parallel elevation of HO-1. CONCLUSION Platelet TGF-β1 contributes to RTV-induced kidney fibrosis and dysfunction, which may be amenable to antioxidant interventions.
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