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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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2
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Folorunso OM, Frazzoli C, Chijioke-Nwauche I, Bocca B, Orisakwe OE. Toxic Metals and Non-Communicable Diseases in HIV Population: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:492. [PMID: 34068196 PMCID: PMC8152992 DOI: 10.3390/medicina57050492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: HIV has been a serious global health concern since its discovery, with about 37.9 million people living with HIV worldwide as of 2018. Sub-Saharan Africa (SSA) accounts for 68% of the infection and contributed 74% of the 1.5 million deaths in 2013 despite having only 12% of the total world population residing in the region. This systematic review has attempted to determine the association between heavy metal toxicity and the occurrence of non-communicable diseases in the HIV/AIDS population. Materials and Methods: Three databases were systematically searched: PubMed, Scopus, and Google Scholar for studies written in English and published between 1 April 2000 and 12 April 2020. Studies were excluded if the main outcomes were not measured or did not meet the inclusion criteria. Results: All the six included studies are cross-sectional in design, and therefore were evaluated using the STROBE checklist. The data extraction was done using an extraction table; the ratio of female to male participants included in the study was 1.09:1. Qualitative analysis was used due to the heterogeneity in the heavy metal biomarkers and the outcome measured by the included studies. Two studies compared the concentration of heavy metals in HIV-positive and HIV-negative participants while one compared the levels between HAART-naïve and HAART-treated participants, and three determined the association between heavy metal toxicity and non-communicable diseases (liver fibrosis, anaemia, and reproductive parameters, respectively) in HIV-positive patients. Conclusions: Blood lead, cadmium, and mercury levels were higher in HIV-seropositive than -seronegative subjects, whereas serum zinc level was lower in HIV-seropositive than -seronegative subjects, but the causal association between heavy metals and non-communicable diseases in HIV subjects is largely unknown. Interdisciplinary research between nutrition, toxicology, and human health is envisaged for primary and secondary prevention and treatment.
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Affiliation(s)
- Opeyemi M. Folorunso
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, Port Harcourt 5323, Rivers State, Nigeria;
| | - Chiara Frazzoli
- Department for Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, 00162 Rome, Italy;
| | - Ifeyinwa Chijioke-Nwauche
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt 5323, Rivers State, Nigeria;
| | - Beatrice Bocca
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Orish E. Orisakwe
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, Port Harcourt 5323, Rivers State, Nigeria;
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt 5323, Rivers State, Nigeria
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3
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Bi W, Xu W, Cheng L, Xue J, Wang Q, Yu F, Xia S, Wang Q, Li G, Qin C, Lu L, Su L, Jiang S. IgG Fc-binding motif-conjugated HIV-1 fusion inhibitor exhibits improved potency and in vivo half-life: Potential application in combination with broad neutralizing antibodies. PLoS Pathog 2019; 15:e1008082. [PMID: 31805154 PMCID: PMC6894747 DOI: 10.1371/journal.ppat.1008082] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/16/2019] [Indexed: 12/23/2022] Open
Abstract
The clinical application of conventional peptide drugs, such as the HIV-1 fusion inhibitor enfuvirtide, is limited by their short half-life in vivo. To overcome this limitation, we developed a new strategy to extend the in vivo half-life of a short HIV-1 fusion inhibitory peptide, CP24, by fusing it with the human IgG Fc-binding peptide (IBP). The newly engineered peptide IBP-CP24 exhibited potent and broad anti-HIV-1 activity with IC50 values ranging from 0.2 to 173.7 nM for inhibiting a broad spectrum of HIV-1 strains with different subtypes and tropisms, including those resistant to enfuvirtide. Most importantly, its half-life in the plasma of rhesus monkeys was 46.1 h, about 26- and 14-fold longer than that of CP24 (t1/2 = 1.7 h) and enfuvirtide (t1/2 = 3 h), respectively. IBP-CP24 intravenously administered in rhesus monkeys could not induce significant IBP-CP24-specific antibody response and it showed no obvious in vitro or in vivo toxicity. In the prophylactic study, humanized mice pretreated with IBP-CP24 were protected from HIV-1 infection. As a therapeutic treatment, coadministration of IBP-CP24 and normal human IgG to humanized mice with chronic HIV-1 infection resulted in a significant decrease of plasma viremia. Combining IBP-CP24 with a broad neutralizing antibody (bNAb) targeting CD4-binding site (CD4bs) in gp120 or a membrane proximal external region (MPER) in gp41 exhibited synergistic effect, resulting in significant dose-reduction of the bNAb and IBP-CP24. These results suggest that IBP-CP24 has the potential to be further developed as a new HIV-1 fusion inhibitor-based, long-acting anti-HIV drug that can be used alone or in combination with a bNAb for treatment and prevention of HIV-1 infection.
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Affiliation(s)
- Wenwen Bi
- Key Laboratory of Medical Molecular Virology of MOE/NHC/CAMS, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Wei Xu
- Key Laboratory of Medical Molecular Virology of MOE/NHC/CAMS, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Liang Cheng
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jing Xue
- Key Laboratory of Human Disease Comparative Medicine, Chinese Ministry of Health, Beijing Key Laboratory for Animal Models of Emerging and Re-emerging Infectious Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
| | - Qian Wang
- Key Laboratory of Medical Molecular Virology of MOE/NHC/CAMS, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Fei Yu
- Key Laboratory of Medical Molecular Virology of MOE/NHC/CAMS, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Shuai Xia
- Key Laboratory of Medical Molecular Virology of MOE/NHC/CAMS, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qi Wang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Guangming Li
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Chuan Qin
- Key Laboratory of Human Disease Comparative Medicine, Chinese Ministry of Health, Beijing Key Laboratory for Animal Models of Emerging and Re-emerging Infectious Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
| | - Lu Lu
- Key Laboratory of Medical Molecular Virology of MOE/NHC/CAMS, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- * E-mail: (LL); (LS); (SJ)
| | - Lishan Su
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail: (LL); (LS); (SJ)
| | - Shibo Jiang
- Key Laboratory of Medical Molecular Virology of MOE/NHC/CAMS, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, United States of America
- * E-mail: (LL); (LS); (SJ)
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Li R, Zhao L, Li L, Hou Z, Zhang D, Wan L, Wei L, Yang Y, Lv J, Ma M, Zhu Y. A Preliminary Study about the Potential Effects of Heavy Metals on the Human Male Reproductive Parameters in HIV-Infected Population in China. Biol Trace Elem Res 2017; 180:39-47. [PMID: 28321634 DOI: 10.1007/s12011-017-0998-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/14/2017] [Indexed: 12/18/2022]
Abstract
Due to the inconsistent effects of human immunodeficiency virus (HIV) on the human male reproduction in previous studies and the impacts of environmental exposures, such as heavy metals, on male reproduction receiving little attention in HIV-infected population, the aim of present study was to investigate whether heavy metals have potential effects on reproductive parameters in HIV-infected men. The current study assessed the associations between semen quality or serum hormone and concentration of the three heavy metal toxicants (lead (Pb), cadmium (Cd), and zinc (Zn)) in seminal, urine, and serum, and 50 HIV-infected men were recruited in the present study. Concentrations of Pb, Cd, and Zn were measured in three fluids by graphite furnace atomic absorption spectrophotometer. Semen analyses were performed according to World Health Organization criteria. Serum samples were analyzed for follicle-stimulating hormone, luteinizing hormone, and testosterone. HIV RNA viral load was determined by HIV virus loads kit. Spearman's rank correlations were used for correlation analyses. The results showed that the concentrations of Pb, Cd, and Zn were significantly correlated with semen quality and serum hormone. HIV-1 virus loads were significantly associated with increased seminal Pb. However, HIV-1 virus loads were not statistically associated with semen quality and serum hormone. Our findings suggested that environmental heavy metals had potential effects on reproductive parameters in HIV-infected men in China.
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Affiliation(s)
- Renyan Li
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Letian Zhao
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Lianbing Li
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Zhiwei Hou
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Danyan Zhang
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Ling Wan
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Li Wei
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Yuyou Yang
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Jing Lv
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Mingfu Ma
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China.
| | - Yijian Zhu
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China.
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Cristelli MP, Cofán F, Rico N, Trullàs JC, Manzardo C, Agüero F, Bedini JL, Moreno A, Oppenheimer F, Miro JM. Estimation of renal function by CKD-EPI versus MDRD in a cohort of HIV-infected patients: a cross-sectional analysis. BMC Nephrol 2017; 18:58. [PMID: 28183270 PMCID: PMC5301369 DOI: 10.1186/s12882-017-0470-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background Accurately determining renal function is essential for clinical management of HIV patients. Classically, it has been evaluated by estimating glomerular filtration rate (eGFR) with the MDRD-equation, but today there is evidence that the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has greater diagnostic accuracy. To date, however, little information exists on patients with HIV-infection. This study aimed to evaluate eGFR by CKD-EPI vs. MDRD equations and to stratify renal function according to KDIGO guidelines. Methods Cross-sectional, single center study including adult patients with HIV-infection. Results Four thousand five hundred three patients with HIV-infection (864 women; 19%) were examined. Median age was 45 years (IQR 37–52), and median baseline creatinine was 0.93 mg/dL (IQR 0.82–1.05). A similar distribution of absolute measures of eGFR was found using both formulas (p = 0.548). Baseline median eGFR was 95.2 and 90.4 mL/min/1.73 m2 for CKD-EPI and MDRD equations (p < 0.001), respectively. Of the 4503 measurements, 4109 (91.2%) agreed, with a kappa index of 0.803. MDRD classified 7.3% of patients as “mild reduced GFR” who were classified as “normal function” with CKD-EPI. Using CKD-EPI, it was possible to identify “normal function” (>90 mL/min/1.73 m2) in 73% patients and “mild reduced GFR” (60–89 mL/min/1.73 m2) in 24.3% of the patients, formerly classified as >60 mL/min/1.73 m2 with MDRD. Conclusions There was good correlation between CKD-EPI and MDRD. Estimating renal function using CKD-EPI equation allowed better staging of renal function and should be considered the method of choice. CKD-EPI identified a significant proportion of patients (24%) with mild reduced GFR (60–89 mL/min/1.73 m2).
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Affiliation(s)
- M P Cristelli
- Kidney Transplant Division, Hospital do Rim (São Paulo, Brazil), Universidade Federal de São Paulo, São Paulo, Brazil
| | - F Cofán
- Nephrology and Renal Transplantation Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - N Rico
- Core Laboratory, Biomedical Diagnosis Centre, Hospital Clínic, Barcelona, Spain
| | - J C Trullàs
- Internal Medicine Service, Hospital de Olot, Girona, Spain.,Medical Sciences Department, University of Girona, Girona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F Agüero
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J L Bedini
- Core Laboratory, Biomedical Diagnosis Centre, Hospital Clínic, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F Oppenheimer
- Nephrology and Renal Transplantation Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
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Seedat F, Martinson N, Motlhaoleng K, Abraham P, Mancama D, Naicker S, Variava E. Acute Kidney Injury, Risk Factors, and Prognosis in Hospitalized HIV-Infected Adults in South Africa, Compared by Tenofovir Exposure. AIDS Res Hum Retroviruses 2017; 33:33-40. [PMID: 27478997 PMCID: PMC5240010 DOI: 10.1089/aid.2016.0098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There are limited data describing acute kidney injury (AKI) in HIV-infected adult patients in resource-limited settings where tenofovir disoproxil fumarate (TDF), which is potentially nephrotoxic, is increasingly prescribed. We describe risk factors for and prognosis of AKI in HIV-infected individuals, stratified by those receiving and those naive to TDF. A prospective case cohort study of hospitalized HIV-infected adults with AKI stratified by TDF exposure. Adults (≥18 years) were recruited: clinical and biochemical data were collected at admission; their renal recovery, discharge, or mortality was ascertained as an in-patient and, subsequently, to a scheduled 3-month follow-up. Among this predominantly female (61%), almost exclusively black African cohort of 175 patients with AKI, 93 (53%) were TDF exposed; median age was 41 years (interquartile range 35-50). Median CD4 count and viral load and creatinine at baseline were 116 cells/mm3 and 110,159 copies/ml, respectively. A greater proportion of the TDF group had severe AKI on admission (61% vs. 43%, p = .014); however, both groups had similar rates of newly diagnosed tuberculosis (TB; 52%) and nonsteroidal anti-inflammatory drug (NSAID; 32%) use. Intravenous fluid was the therapeutic mainstay; only seven were dialyzed. Discharge median serum creatinine (SCr) was higher in the TDF group (p = .032) and fewer in the TDF group recovered renal function after 3 months (p = .043). Three-month mortality was 27% in both groups, but 55% of deaths occurred in hospital. Those that died had a higher SCr and more severe AKI than survivors; TB was diagnosed in 33 (70%) of those who died. AKI was more severe and renal recovery slower in the TDF group; comorbidities, risk factors, and prognosis were similar regardless of TDF exposure. Because TB is linked to higher mortality, TB coinfection in HIV-infected patients with AKI warrants more intensive monitoring. In all those with poor renal recovery, our data suggest that a lower threshold for dialysis is needed.
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Affiliation(s)
- Faheem Seedat
- Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Centre for TB Research, Baltimore, Maryland
| | - Katlego Motlhaoleng
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Pattamukkil Abraham
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Dalu Mancama
- Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Abstract
OBJECTIVE Knowledge on characteristics and outcome of ICU patients with AIDS is highly limited. We aimed to determine the main reasons for admission and outcome in ICU patients with AIDS and trends over time therein. DESIGN A retrospective study within the Dutch National Intensive Care Evaluation registry. SETTING Dutch ICUs. PATIENTS We used data collected between 1997 and 2014. Characteristics of patients with AIDS were compared with ICU patients without AIDS, matched for age, sex, admission type, and admission year. Joinpoint regression analysis was applied to study trends over time. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We included 1,127 patients with AIDS and 4,479 matched controls. The main admission diagnoses of patients with AIDS were respiratory infection (28.6%) and sepsis (16.9%), which were less common in controls (7.7% and 7.5%, respectively; both p < 0.0001). Patients with AIDS had increased severity of illness and in-hospital mortality (28.2% vs 17.8%; p < 0.0001) compared with controls, which was associated with a higher rate of infections at admission in patients with AIDS (58.4% vs 25.5%). Over time, the proportion of patients with AIDS admitted with an infection decreased (75% in 1999 to 56% in 2013). Mortality declined in patients with AIDS (39% in 1999 to 16% in 2013), both in patients with or without an infection. Mortality also declined in matched controls without AIDS, but to a lesser extent. CONCLUSION Infections are still the main reason for ICU admission in patients with AIDS, but their prevalence is declining. Outcome of patients with AIDS continued to improve during a time of widespread availability of combination antiretroviral therapy, and mortality is reaching levels similar to ICU patients without AIDS.
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8
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Korolevskaya LB, Shmagel KV, Shmagel NG. Characteristics of Circulating Immune Complexes in HIV-Infected Patients with Different Viral Load. Bull Exp Biol Med 2015; 159:469-71. [PMID: 26388572 DOI: 10.1007/s10517-015-2994-6] [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: 04/02/2014] [Indexed: 10/23/2022]
Abstract
Serum concentration of antiviral antibodies was measured in HIV-infected patients with different viral load. It was found that higher concentrations of HIV-antigens correspond to higher titer of antiviral antibodies. Circulating immune complexes were isolated from patients' serum to estimate their size and immunoglobulin composition. High levels of small IgG- and IgM-containing complexes were identified in HIV-infected patients. In patients receiving antiretroviral treatment, the content of these complexes was significantly lower than in patients with high HIV load. This attests to positive role of specific therapy in preventing immune complex-associated pathology in HIV patients.
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Affiliation(s)
- L B Korolevskaya
- Institute of Ecology and Genetics of Microorganisms, Ural Division of the Russian Academy of Sciences, Ekaterinburg, Russia. .,Regional Center on Prophylaxis and Combating of AIDS and Infection Diseases, Perm', Russia.
| | - K V Shmagel
- Institute of Ecology and Genetics of Microorganisms, Ural Division of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - N G Shmagel
- Regional Center on Prophylaxis and Combating of AIDS and Infection Diseases, Perm', Russia
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9
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López De León JI, Mata-Marín JA, Andrade-Fuentes K, Huerta-Garcia G, Domínguez-Hemosillo JC, Gaytán-Martínez J. Strong correlation between protein reagent strip and protein-to-creatinine ratio for detection of renal dysfunction in HIV-infected patients: a cross-sectional study. AIDS Res Ther 2015; 12:8. [PMID: 25798180 PMCID: PMC4367895 DOI: 10.1186/s12981-015-0047-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/11/2015] [Indexed: 12/13/2022] Open
Abstract
Background Tubular dysfunction is common in HIV-infected people and detection of proteinuria is essential to identify this problem. In low-income countries, resources for detection of proteinuria using the Kidney Disease Improve Global Outcomes (KDIGO) gold standard urinary protein/creatinine ratio (uPCR) is rarely possible, and use of the protein reagent strip (PRS) could be an option in these places. The aims of this study were to establish the concordance between PRS and uPCR to detect tubular proteinuria in HIV-infected people, and to assess the sensitivity and specificity of PRS as a diagnostic method in this group. Methods A cross-sectional study was conducted to evaluate the correlation between the two techniques to detect protein in urine. Participants were enrolled for a period of 6 months. The measurements were performed in participants who were on highly active antiretroviral therapy (HAART) or prior to the start of treatment. Proteinuria was defined as uPCR ≥ 150 mg/g, and/or ≥ trace on PRS. A phi coefficient was calculated to establish the degree of correlation. We assessed the sensitivity and specificity of PRS compared with uPCR using standard methods. Results A total of 799 subjects were included. Of these, 737 (92%) were men. The mean age was 32.9 years (±10.1 years). Most (561, 70%) were on antiretroviral treatment. The mean estimated glomerular filtration rate (eGFR) calculated according to Modification of Diet in Renal Disease (MDRD)-4 was 113.0 mL/min (±22.6). Comorbidities included diabetes mellitus (10, 1.3%) and hypertension (17, 2.1%). The prevalence of proteinuria detected by PRS was 8.3% (n = 66) and by uPCR 10.6% (n = 85). The concordance assessed by phi correlation coefficient was 0.70, p < 0.001, with a sensitivity of 51.7% (95% confidence interval [CI] 41%–62%) and specificity 97% (95% CI 39%–97%). Conclusions There is a high concordance between detection of proteinuria by PRS and uPCR. Therefore, in low-income countries PRS can be helpful for detecting tubular damage in people infected with HIV.
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Taha H, Newby K, Das A, Das S. Attitude of patients with HIV infection towards organ transplant between HIV patients. A cross-sectional questionnaire survey. Int J STD AIDS 2015; 27:13-8. [PMID: 25614524 DOI: 10.1177/0956462414568902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
Abstract
This study examined the HIV patients' attitudes towards the practice of organ transplant between HIV patients using a cross-sectional survey design. In total, 206 patients participated with a mean age of 42 (±8.8) years. The majority (70%) were black African and women (54%), and 83% described themselves as heterosexual. Most participants (n = 171, 83%) were on treatment, and 159 (93%) had viral load less than 40 copies/ml. Mean duration of illness and mean duration of treatment were 77 (±42.7) and 68 (±41) months, respectively. Of all participants, 128 (62%) reported that they would consider donating either any organ or a specific organ/s to an HIV patient, 33 (16%) would not consider it and 45 (22%) were unsure about donating their organs. Furthermore, 113 (55%) participants would consider receiving an organ from an HIV patient, 37 (18%) would not consider it, and 56 (27%) were unsure. Ninety-eight participants (42%) reported that they would consider both donating and receiving an organ. Multinomial logistic regression analysis found that significantly more Black African than Caucasian participants were unsure about organ donation (p = 0.011, OR = 3.887). Participants with longer duration of infection were significantly less likely to consider receiving an organ from an HIV patient (p = 0.036, OR = 1.297). Overall, the study findings indicated that the majority of participants were in favour of organ transplant between HIV patients. Use of HIV-infected donors could potentially reduce current organ waiting list among HIV patients.
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Affiliation(s)
- Huda Taha
- GU/HIV Medicine, Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Katie Newby
- Applied Research Centre in Health and Lifestyle Interventions, Coventry University, Coventry, UK
| | - Archik Das
- School of Medicine, Birmingham University, Birmingham, UK
| | - Satyajit Das
- GU/HIV Medicine, Coventry and Warwickshire Partnership Trust, Coventry, UK
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Brennan A, Morley D, O'Leary AC, Bergin CJ, Horgan M. Determinants of HIV outpatient service utilization: a systematic review. AIDS Behav 2015; 19:104-19. [PMID: 24907780 DOI: 10.1007/s10461-014-0814-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Demands on HIV services are increasing as a consequence of the increased life-expectancy of HIV patients in the highly active antiretroviral therapy era. Understanding the factors that influence utilization of ambulatory HIV services is useful for planning service provision. This study reviewed factors associated with utilization of hospital based HIV out-patient services. Studies reporting person-based utilization rates of HIV-specific outpatient services broken down by patient or healthcare characteristics were eligible for inclusion. The Andersen Behavioral Model was used to organize the information extracted into pre-disposing, enabling and need components. Ten studies were included in the final review. Older age, private insurance, urban residence, lower CD4 counts, a diagnosis of AIDS, or anti-retroviral treatment were associated with higher utilization rates. The results of this review are consistent with existing knowledge regarding HIV patients' use of health services. Little information was identified on the influence of health service characteristics on utilization of out-patient services.
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Affiliation(s)
- Aline Brennan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland,
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Bonjoch A, Juega J, Puig J, Pérez-Alvarez N, Aiestarán A, Echeverría P, Pérez V, Clotet B, Romero R, Bonet J, Negredo E. High prevalence of signs of renal damage despite normal renal function in a cohort of HIV-infected patients: evaluation of associated factors. AIDS Patient Care STDS 2014; 28:524-9. [PMID: 25238104 DOI: 10.1089/apc.2014.0172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Renal disorders are an emerging problem in HIV-infected patients. We performed a cross-sectional study of the first 1000 HIV-infected patients attended at our HIV unit who agreed to participate. We determined the frequency of renal alterations and its related risk factors. Summary statistics and logistic regression were applied. The study sample comprised 970 patients with complete data. Most were white (94%) and men (76%). Median (IQR) age was 48 (42-53) years. Hypertension was diagnosed in 19%, dyslipidemia in 27%, and diabetes mellitus in 3%. According to the Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation, 29 patients (3%) had an eGFR<60 ml/min/1.73 m(2); 18 of them (62%) presented altered albumin/creatinine and protein/creatinine (UPC or UAC) ratios. Of the patients with eGFR>60 mL/min, it was present in 293 (30%), 38 of whom (7.1%) had UPC>300 mg/g. Increased risk of renal abnormalities was correlated with hypertension (OR, 1.821 [95%CI, 1.292;2.564]; p=0.001), age (OR, 1.015 [95%CI, 1.001;1.030], per one year; p=0.040), and use of tenofovir disoproxil fumarate (TDF) plus protease inhibitor (PI), (OR, 1.401 [95%CI, 1.078;1.821]; p=0.012). Current CD4 cell count was a protective factor (OR, 0.9995 [95%CI, 0.9991;0.9999], per one cell; p=0.035). A considerable proportion of patients presented altered UPC or UAC ratios, despite having an eGFR>60 mL/min. CD4 cell count was a protective factor; age, hypertension, and use of TDF plus PIs were risk factors for renal abnormalities. Based on our results, screen of renal abnormalities should be considered in all HIV-infected patients to detect these alterations early.
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Affiliation(s)
- Anna Bonjoch
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Javier Juega
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Jordi Puig
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Nuria Pérez-Alvarez
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Statistics and Operations Research Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Aintzane Aiestarán
- Statistics and Operations Research Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Patricia Echeverría
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Vanessa Pérez
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Bonaventura Clotet
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- IrsiCaixa Foundation, Badalona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Ramon Romero
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Josep Bonet
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Eugenia Negredo
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
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A clinical prediction score for targeted creatinine testing before initiating tenofovir-based antiretroviral treatment in Cambodia. J Acquir Immune Defic Syndr 2014; 65:e150-2. [PMID: 24121759 DOI: 10.1097/qai.0000000000000022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Renal disease accounts for significant morbidity and mortality in patients with HIV-1 infection. HIV-associated nephropathy (HIVAN) is an important cause of end stage renal disease in this population. Although multiple genetic, clinical, and laboratory characteristics such as Apolipoproetin-1 genetic polymorphism, high viral load, low CD-4 count, nephrotic range proteinuria, and increased renal echogenicity on ultrasound are predictive of HIVAN, kidney biopsy remains the gold standard to make the definitive diagnosis. Current treatment options for HIVAN include initiation of combined active antiretroviral therapy, blockade of the renin-angiotensin system, and steroids. In patients with progression of HIVAN, renal transplant should be pursued as long as their systemic HIV infection is controlled.
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Affiliation(s)
- Sana Waheed
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Baxi SM, Greenblatt RM, Bacchetti P, Scherzer R, Minkoff H, Huang Y, Anastos K, Cohen M, Gange SJ, Young M, Shlipak MG, Gandhi M. Common clinical conditions - age, low BMI, ritonavir use, mild renal impairment - affect tenofovir pharmacokinetics in a large cohort of HIV-infected women. AIDS 2014; 28:59-66. [PMID: 24275255 PMCID: PMC3956315 DOI: 10.1097/qad.0000000000000033] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Tenofovir is used commonly in HIV treatment and prevention settings, but factors that correlate with tenofovir exposure in real-world settings are unknown. DESIGN Intensive pharmacokinetic studies of tenofovir in a large, diverse cohort of HIV-infected women over 24 h at steady state were performed and factors that influenced exposure [assessed by areas under the concentration-time curves (AUCs)] identified. METHODS HIV-infected women (n = 101) on tenofovir-based therapy underwent intensive 24-h pharmacokinetic sampling. Data on race/ethnicity, age, exogenous steroid use, menstrual cycle phase, concomitant medications, recreational drugs and/or tobacco, hepatic and renal function, weight, and BMI were collected. Multivariable models using forward stepwise selection identified factors associated with effects on AUC. Glomerular filtration rates (GFRs) prior to starting tenofovir were estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation using both creatinine and cystatin-C measures. RESULTS The median (range) of tenofovir AUCs was 3350 (1031-13 911) ng × h/ml. Higher AUCs were associated with concomitant ritonavir use (1.33-fold increase, P = 0.002), increasing age (1.21-fold increase per decade, P = 0.0007), and decreasing BMI (1.04-fold increase per 10% decrease in BMI). When GFR was calculated using cystatin-C measures, mild renal insufficiency prior to tenofovir initiation was associated with higher subsequent exposure (1.35-fold increase when pre-tenofovir GFR <70 ml/min, P = 0.0075). CONCLUSION Concomitant ritonavir use, increasing age, decreasing BMI, and lower GFR prior to tenofovir initiation as estimated by cystatin C were all associated with elevated tenofovir exposure in a diverse cohort of HIV-infected women. Clinicians treating HIV-infected women should be aware of common clinical conditions that affect tenofovir exposure when prescribing this medication.
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Esposito P, Rampino T, Gregorini M, Fasoli G, Gamba G, Dal Canton A. Renal diseases in haemophilic patients: pathogenesis and clinical management. Eur J Haematol 2013; 91:287-94. [PMID: 23651176 DOI: 10.1111/ejh.12134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 02/05/2023]
Abstract
Haemophilia A and B are genetic X-linked bleeding disorders, caused by mutations in genes encoding factors VIII and IX, respectively. Clinical manifestations of haemophilia are spontaneous haemorrhage or acute bleeding caused by minor trauma, resulting in severe functional consequences that can culminate in a debilitating arthropathy. Life expectancy and quality of life of patients with haemophilia have dramatically improved over the last years, mainly for new therapeutic options and the awareness to the risk of HCV and HIV infections. Different clinical problems arise from this important change in history of patients with haemophilia. In particular, ageing-related diseases, such as diabetes, hypertension and cancer, and chronic viral infections are emerging as new challenges in this patient population. Among the different types of chronic illnesses, renal diseases are of special interest as they involve some difficult management issues. In fact, decisions regarding adequate preventive strategies and viral infection treatment, the choice of the dialytic modality, placement of vascular access and prescription of dialytic treatments are particularly complicated, because only few data are available. In this review, we discuss the pathogenesis of renal damage in patients with haemophilia, especially in those with blood-transmitted viral infections, and the major issues about the management of renal diseases, including problems related to dialytic treatment and kidney transplantation, providing practical algorithms to guide the clinical decision-making process.
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Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico S.Matteo and University of Pavia, Pavia, Italy
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Xu X, Hu H, Dailey AB, Kearney G, Talbott EO, Cook RL. Potential health impacts of heavy metals on HIV-infected population in USA. PLoS One 2013; 8:e74288. [PMID: 24023932 PMCID: PMC3759466 DOI: 10.1371/journal.pone.0074288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/30/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States. METHODS We used the National Health and Nutrition Examination Survey (NHANES) 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects. RESULTS In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03) after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates. CONCLUSIONS Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes.
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Affiliation(s)
- Xiaohui Xu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Hui Hu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Amy B. Dailey
- Health Sciences Department, Gettysburg College, Gettysburg, Pennsylvania, United States of America
| | - Greg Kearney
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - Evelyn O. Talbott
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States of America
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Prevalence of renal disease within an urban HIV-infected cohort in northern Italy. Clin Exp Nephrol 2013; 18:104-12. [PMID: 23712539 DOI: 10.1007/s10157-013-0817-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 05/02/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Renal disease is an increasingly recognized noninfectious comorbidity associated with human immunodeficiency virus (HIV) infection. METHODS Our retrospective, cross-sectional study evaluated prevalence of nephropathy among HIV-infected patients followed up in our outpatient clinic during the year 2011. Renal dysfunction and chronic kidney disease (CKD) were defined as estimated glomerular filtration rate (eGFR) <90 ml/min per 1.73 m(2) and as renal damage or eGFR <60 ml/min per 1.73 m(2) over a 3-month or greater period, respectively. RESULTS We enrolled 894 HIV-infected patients with a mean age of 44.2 years and a mean current CD4 lymphocyte count of 508 cells/mm(3). The prevalence of renal dysfunction and CKD was 27.4 and 21.3 %, respectively. Older age, male gender, hypertension, diabetes, proteinuria, hypertriglyceridemia, lower nadir CD4 cell count, current use of tenofovir or tenofovir plus a ritonavir-boosted protease inhibitor were independently associated with renal dysfunction. CONCLUSION Renal dysfunction is a frequent comorbidity among HIV-infected persons and requires a careful clinical and laboratory monitoring of renal function.
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