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Chazot R, Botelho-Nevers E, Frésard A, Maillard N, Mariat C, Lucht F, Gagneux-Brunon A. Diagnostic challenges of kidney diseases in HIV-infected patients. Expert Rev Anti Infect Ther 2017; 15:903-915. [PMID: 28898114 DOI: 10.1080/14787210.2017.1379395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a prevalent comorbidity in persons living with HIV infection (PLWH) associated with an increase in cardiovascular morbidity and all-cause mortality. Furthermore, early diagnosis of CKD is difficult in PLWH. Areas covered: We reviewed the main diagnostic tools for CKD in PLWH, and discussed their strengths and limits. We performed a literature search on PubMed to identify reviews and clinical trials dealing with attractive kidney biomarkers of CKD in PLWH, with the following key words: 'HIV AND kidney', 'HIV AND Kidney biomarkers', 'CKD AND Kidney biomarkers'. Expert commentary: Currently, CKD diagnosis is based on the estimation of Glomerular Filtration Rate (GFR), and measurement of proteinuria by urine protein/creatinine ratio (uPCR). These parameters are independent and complementary predictors of outcomes. GFR estimates are lacking in accuracy in PLWH. The best GFR estimate is CKD-EPI study equation. Moreover, low-grade proteinuria is associated with an increased risk of kidney disease progression in PLWH, and guidelines derived from the general population may lack sensitivity. Different biomarkers of kidney diseases like N-acetyl beta glucosaminidase (NAG), Kidney Injury Molecule-1 (KIM-1), and Alpha-1-microglobulin may predict kidney disease progression and mortality in PLWH. Others may help clinicians detect antiretroviral-induced tubulopathy, or predict cardiovascular events. More studies are needed to validate the routine use of these types of biomarkers.
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Affiliation(s)
- Robin Chazot
- a Department of Nephrology, Dialysis, Transplantation and Hypertension , University Hospital of Saint-Étienne , Saint-Étienne , France
| | - Elisabeth Botelho-Nevers
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Anne Frésard
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Nicolas Maillard
- a Department of Nephrology, Dialysis, Transplantation and Hypertension , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Christophe Mariat
- a Department of Nephrology, Dialysis, Transplantation and Hypertension , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Frédéric Lucht
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
| | - Amandine Gagneux-Brunon
- b Department of Infectious and Tropical Diseases , University Hospital of Saint-Étienne , Saint-Étienne , France.,c GIMAP - Groupe sur l'Immunité des Muqueuses et Agents Pathogènes, EA 3064 , Université Jean Monnet, Université de Lyon , Saint-Étienne , France
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Atta MG, Estrella MM, Fine DM, Zook K, Monroy Trujillo JM, Stein JH, Lucas GM. Correlates and Longitudinal Renal and Cardiovascular Implications of FGF23 Levels in HIV-Positive Individuals. PLoS One 2016; 11:e0155312. [PMID: 27176000 PMCID: PMC4866696 DOI: 10.1371/journal.pone.0155312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/27/2016] [Indexed: 11/19/2022] Open
Abstract
Fibroblast growth factor23 (FGF23), an early marker of kidney dysfunction, is associated with cardiovascular death. Its role in HIV-positive individuals is unknown. We measured FGF23 in 100 HIV-negative and 191 HIV-positive nondiabetic adults with normal baseline estimated glomerular filtration rate (GFR). We measured GFR by iohexol annually, albumin-creatinine ratio (ACR) every 6 months, as well as pulse wave velocity, carotid plaque, and carotid intima media thickness (IMT) at baseline and 2 years. Progressive albuminuria was defined as follow-up ACR ≥2-fold than baseline and ≥30 mg/g. Regression models assessed associations of FGF23 with baseline factors and longitudinal changes in disease markers. FGF23 levels were similar in HIV serostatus. Among HIV-positive persons, factors independently associated with higher baseline FGF23 levels included female (adjusted ratio of geometric means [95% CI],1.46 [1.21,1.76]), serum phosphorus (1.20 [1.03,1.40]), HCV (1.31 [1.10,1.56]) and non-suppressed HIV RNA (1.27 [1.01,1.76]). At baseline, FGF23 was not associated with GFR, albuminuria, carotid plaque, or carotid IMT in cross-sectionally adjusted analysis of HIV-positive individuals. However, higher baseline FGF23 was associated with progressive albuminuria (odds ratio1.48 [95% CI]:1.05,2.08) and a more rapid increase in IMT (13 μm/year, 95% CI,3,24). These findings suggest a role for FGF23 in HIV-positive populations in identifying patients at greater risk for cardiovascular and kidney disease.
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Affiliation(s)
- Mohamed G. Atta
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America
| | - Michelle M. Estrella
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America
| | - Derek M. Fine
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America
| | - Katie Zook
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America
| | - Jose Manuel Monroy Trujillo
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America
| | - James H. Stein
- Department of Medicine, Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53792, United States of America
| | - Gregory M. Lucas
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, 21287, United States of America
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Young J, Mucsi I, Rollet-Kurhajec KC, Klein MB. Fibroblast growth factor 23: associations with antiretroviral therapy in patients co-infected with HIV and hepatitis C. HIV Med 2015; 17:373-9. [PMID: 26307135 DOI: 10.1111/hiv.12305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Fibroblast growth factor 23 (FGF23) has been associated with cardiovascular mortality. We estimate associations between the level of plasma FGF23 and exposure to abacavir (ABC) and to other components of antiretroviral therapy in patients co-infected with HIV and hepatitis C. METHODS Both intact and c-terminal FGF23 were measured in plasma using commercial assays for a sub-cohort of 295 patients selected at random from the 1150 patients enrolled in the Canadian Co-infection Cohort. The multiplicative effects of antiretroviral drug exposures and covariates on median FGF23 were then estimated using a hierarchical Bayesian model. RESULTS The median level of intact FGF23 was independent of either past or recent exposure to abacavir, with multiplicative ratios of 1.00 and 1.07, 95% credible intervals 0.90-1.12 and 0.94-1.23, respectively. Median intact FGF23 tended to increase with past use of both nonnucleoside reverse-transcriptase inhibitors and protease inhibitors, but tended to decrease with recent use of either tenofovir, efavirenz or lopinavir. There were no obvious associations between the median level of c-terminal FGF23 and individual drugs or drug classes. Age, female gender, smoking and the aspartate aminotransferase to platelet ratio index were all associated with a higher median c-terminal FGF23 but not with a higher median intact FGF23. CONCLUSIONS The level of FGF23 in plasma was independent of exposure to ABC. Lower levels of intact FGF23 with recent use of tenofovir, efavirenz or lopinavir may reflect their adverse effects on bone and vitamin D metabolism relative to other drugs in their respective drug classes.
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Affiliation(s)
- J Young
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - I Mucsi
- Department of Medicine, Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - K C Rollet-Kurhajec
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - M B Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
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Domingo P, Lamarca MK, Gallego-Escuredo JM, Torres F, Domingo JC, Villarroya J, Gutierrez MDM, Mateo MG, Vidal F, Villarroya F, Giralt M. Circulating fibroblast growth factor 23 (FGF23) levels are associated with metabolic disturbances and fat distribution but not cardiovascular risk in HIV-infected patients. J Antimicrob Chemother 2015; 70:1825-32. [PMID: 25700720 DOI: 10.1093/jac/dkv027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/25/2015] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Dyslipidaemia, insulin resistance, metabolic syndrome and HIV/HAART-associated lipodystrophy syndrome (HALS) are common comorbidities in HIV-1-infected patients, which may increase cardiovascular risk. Fibroblast growth factor 23 (FGF23) is a bone-derived hormone with effects on metabolism and phosphate homeostasis. The aim of this study was to determine the relationship between FGF23 levels, metabolic alterations, fat distribution and cardiovascular risk. METHODS This was a cross-sectional study. Serum FGF23 levels were analysed in 152 patients and 34 healthy control individuals. Patients belonged to three groups: HIV-1-infected, antiretroviral-treated patients who have developed HALS (n = 60); HIV-1-infected, antiretroviral-treated patients without HALS (n = 43); and untreated (naive) HIV-1-infected patients (n = 49). Serum FGF23 levels were compared with lipid and glucose homeostasis parameters, fat distribution and cardiovascular risk. RESULTS Serum FGF23 levels were increased in HIV-1-infected patients, but the increase was most marked in those with HALS. FGF23 levels showed a strong positive correlation with age, indicators of dyslipidaemia (LDL cholesterol, polyunsaturated fatty acids and monounsaturated fatty acids), HALS parameters (trunk/appendicular fat ratio), insulin resistance (fasting insulin and homeostasis model assessment of insulin resistance) and C-reactive protein. FGF23 levels correlated with cardiovascular risk but correlation was lost after age adjustment. CONCLUSIONS FGF23 levels are increased in HIV-1-infected patients, especially in those with HALS, and this increase is associated with dyslipidaemia, insulin resistance, metabolic syndrome, fat distribution and parameters of inflammation. FGF23 is not associated with cardiovascular risk when age is taken into account.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Karuna Lamarca
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José M Gallego-Escuredo
- Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain
| | - Ferran Torres
- Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan C Domingo
- Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain
| | - Joan Villarroya
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain
| | - M Del Mar Gutierrez
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Gracia Mateo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Vidal
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Francesc Villarroya
- Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain
| | - Marta Giralt
- Departament de Bioquimica i Biologia Molecular and Institut de Biomedicina de la Universitat de Barcelona (IBUB), CIBER Fisiopatología de la Obesidad y Nutrición, Barcelona, Spain
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