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Hosseini-Moghaddam SM, Kang Y, Bota SE, Weir MA. Renal Transplantation in HIV-positive and HIV-negative People With Advanced Stages of Kidney Disease: Equity in Transplantation. Open Forum Infect Dis 2024; 11:ofae182. [PMID: 38737424 PMCID: PMC11083635 DOI: 10.1093/ofid/ofae182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/30/2023] [Indexed: 05/14/2024] Open
Abstract
Background People with HIV are at a greater risk of end-stage kidney disease than the general population. Considering the risk of death after end-stage kidney disease, access to renal transplantation in people with HIV is critically important. Methods We included all adult patients on chronic dialysis in Ontario, Canada, between 1 April 2007 and 31 December 2020. We determined the probability of kidney transplantation with competing risk of death over time since the initiation of dialysis by calculating the adjusted subdistribution hazard ratios (sdHR; 95% confidence interval [CI]). We also compared long-term renal allograft and posttransplant mortality outcomes between HIV-negative and HIV-positive persons. Results Of 40 686 people (median age, 68 years; interquartile range, 57-77; 38.4% women), 173 were HIV-positive and 40 513 were HIV-negative. The incidence of kidney transplantation in HIV-negative and HIV-positive patients was 40.5 (95% CI, 39.4-41.6)/1000 person-years and 35.0 (95% CI, 22.8-53.7)/1000 person-years, respectively (P = .51). Considering the competing risk of death, HIV-positive people had a significantly lower chance of receiving kidney transplants than HIV-negative people (sdHR, 0.46 [95% CI, .30-.70]). The long-term allograft failure risk was not significantly different between HIV-negative and HIV-positive people, considering the competing risk of posttransplant death (sdHR, 1.71 [95% CI, .46-6.35]). Conclusions Although the incidence and crude probability of kidney transplantation were similar among HIV-negative and HIV-positive persons in this cohort, those with HIV had a significantly lower likelihood of kidney transplantation than those without HIV. Having HIV was not significantly associated with a poor long-term allograft outcome compared with patients without HIV.
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Affiliation(s)
- Seyed M Hosseini-Moghaddam
- ICES, Kidney, Dialysis & Transplantation Research Program, London, Ontario, Canada
- Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, Western University, London, Ontario, Canada
| | - Yuguang Kang
- ICES, Kidney, Dialysis & Transplantation Research Program, London, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Sarah E Bota
- ICES, Kidney, Dialysis & Transplantation Research Program, London, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Matthew A Weir
- ICES, Kidney, Dialysis & Transplantation Research Program, London, Ontario, Canada
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Edrosolan KA, Shlipak MG, Scherzer R, Estrella MM, Gustafson D, Karim R, Fisher M, Cohen M, Kassaye S, Dumond J, Abraham A, McCulloch CE, Ascher SB. Mediation analysis of chronic kidney disease risk factors using kidney biomarkers in women living with HIV. AIDS 2024; 38:813-824. [PMID: 38224361 PMCID: PMC11025668 DOI: 10.1097/qad.0000000000003839] [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: 01/16/2024]
Abstract
OBJECTIVE Novel urinary biomarkers reflecting kidney tubule health are associated with chronic kidney disease (CKD) risk in persons living with HIV. However, it is unknown whether these biomarkers provide mechanistic insight into the associations between clinical risk factors for CKD and subsequent CKD risk. METHODS Among 636 women living with HIV in the Women's Interagency HIV Study with estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m 2 , we used a counterfactual approach to causal mediation analysis to evaluate the extent to which systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin a1c (Hba1c) and serum albumin associations with incident CKD were mediated by eight urine proteins. These biomarkers reflect proximal tubular reabsorptive dysfunction (α1-microglobulin [a1m], β2-microglobulin, trefoil factor 3); tubular injury (interleukin 18 [IL-18], kidney injury molecule 1 [KIM-1]); kidney repair (epidermal growth factor); tubular reserve (uromodulin); and glomerular injury (urinary albumin). Incident CKD was defined as eGFR <60 ml/min/1.73 m 2 measured at two consecutive 6-month visits with an average annual eGFR decline ≥3% per year. RESULTS During a median follow-up of 7 years, 11% developed CKD. Urinary albumin and KIM-1 mediated 32% (95% CI: 13.4%, 76.6%) and 23% (6.9%, 60.7%) of the association between SBP and incident CKD, respectively; and 19% (5.1%, 42.3%) and 22% (8.1%, 45.7%) of the association between DBP and incident CKD, respectively. Urinary albumin, α1m, and IL-18 were significant mediators of the association between Hba1c and incident CKD. None of the eight biomarkers mediated the association between serum albumin and incident CKD. CONCLUSIONS Among women living with HIV, several urinary biomarkers reflecting distinct dimensions of kidney health may partially explain the associations between SBP, DBP, and Hba1c and subsequent CKD risk.
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Affiliation(s)
- Kristienne A Edrosolan
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco
- Department of Medicine, Division of Nephrology, University of California, San Francisco, CA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Health Sciences University, New York, NY
| | - Roksana Karim
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Molly Fisher
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, NY
| | - Mardge Cohen
- Stroger Hospital of Cook County Health and Human Services, Chicago, IL
| | - Seble Kassaye
- Division of Infectious Diseases, Georgetown University, Washington DC
| | - Julie Dumond
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
| | - Alison Abraham
- Department of Epidemiology, University of Colorado School of Public Health, Denver, CO
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco
- Division of Hospital Medicine, University of California Davis, Sacramento, CA, USA
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Deshpande RP, CS C, Bhadoria RS. Outcomes of HIV-infected Patients on Dialysis: Experience at a Tertiary Care Center. Indian J Nephrol 2024; 34:139-143. [PMID: 38681011 PMCID: PMC11044686 DOI: 10.4103/ijn.ijn_523_21] [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: 12/16/2021] [Accepted: 08/21/2022] [Indexed: 05/01/2024] Open
Abstract
Background Human immunodeficiency virus (HIV) infection is a major public health problem. These patients are at an increased risk for end-stage kidney disease. Both hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are the accepted modalities of treatment. Materials and Methods In this retrospective study, we included all HIV-positive end-stage kidney disease (ESKD) patients who were on dialysis - HD or CAPD - for at least 1 month. Data were collected from the dialysis charts and analyzed. Results There were 20 patients in the CAPD group and 76 patients in the HD group. Mean age was 49.6 ± 8.73 years in the CAPD group and 46.28 ± 9.02 years in the HD group. Hypertension and diabetes were the common causes for ESKD. Mean survival was slightly better in CAPD group (20.94 vs. 15.46 months). The HD group had higher mortality within 12 months of dialysis initiation, and infection was the cause for early deaths. Mean infection episodes was 2.1 in HD group and 3.1 in CAPD group. CAPD patients with low albumin (<2.5 g/dl) had higher peritonitis rates. Conclusion Managing HIV-positive dialysis patients remains challenging. In our study, survival was marginally better in the CAPD group. In both groups, low CD4 count was associated with more infections and low albumin with more peritonitis episodes. A study incorporating more peritoneal dialysis (PD) patients, longer follow-ups, and a matched non-HIV control will throw more light on patient outcomes.
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Affiliation(s)
- Ravi Prakash Deshpande
- Department of Nephrology, ST. Johns National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Chetan CS
- Department of Nephrology, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Reis AO, Rocco Suassuna JH, Cunha CB, Portela EN, Veloso VG, Grinszteijn B, Cardoso SW. Evaluation of Glomerular Filtration Rate Trends in People Living With HIV Corrected by the Baseline Glomerular Filtration Rate. J Acquir Immune Defic Syndr 2023; 94:82-90. [PMID: 37276245 DOI: 10.1097/qai.0000000000003232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Chronic kidney disease, for which estimated glomerular filtration rate (eGFR) trajectories are early markers, is frequent in people living with HIV. SETTING Identify eGFR trajectory patterns according to kidney function and assess associated factors over a 13-year follow-up period. METHODS We evaluated longitudinal changes and its associated factors in eGFR of 3366 participants according to kidney function with a 2-level, linear, mixed model. RESULTS Participants with initial kidney dysfunction experienced a slight eGFR increase, whereas others showed a slight decrease. A weak relationship was observed between baseline eGFR and its variation over time. Baseline eGFR was affected by age, CD4 + count, viral load, hypertension, hyperlipidemia, AIDS-defining illness and tenofovir (TDF) with integrase inhibitor (INSTI) or efavirenz. Significant factors for eGFR change included the following: in kidney dysfunction, CD4 + cell count of >350 cells per cubic millimeter and undetectable viral load increased eGFR, whereas TDF + protease inhibitor decreased eGFR; in mildly decreased kidney function, CD4 + cell count of >350 cells per cubic millimeter, AIDS-defining illness, and TDF + efavirenz increased eGFR, whereas age, hypertension, hyperlipidemia, and TDF + INSTI decreased eGFR; in normal kidney function, age, CD4 + cell count of > 350 cells per cubic millimeter, undetectable viral load, hypertension, hyperlipidemia, and TDF + INSTI decreased eGFR, whereas TDF + efavirenz increased eGFR (all P value for interaction < 0.05). CONCLUSION Our findings suggest that eGFR trajectories varied widely between individuals in people living with HIV. In the lower eGFR group, virus-related factors were more relevant, whereas traditional risk factors for renal dysfunction were more prominent in the highest eGFR group.
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Affiliation(s)
- Amanda Orlando Reis
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
- Clínical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José H Rocco Suassuna
- Clínical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cynthia B Cunha
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Estevão N Portela
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Valdilea G Veloso
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Beatriz Grinszteijn
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
| | - Sandra Wagner Cardoso
- SDT/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro Brazil; and
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Abe T, Ishii D, Imura Y, Noguchi A, Kitajima K, Takeuchi Y, Wada T, Yoshida K. Importance of multidisciplinary collaboration for smooth kidney transplantation in HIV-infected patients with chronic kidney disease: a case report. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00435-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Antiretroviral therapy (ART) has reduced mortality caused by AIDS resulting from HIV infection. Meanwhile, the prevalence of chronic kidney disease, a chronic HIV complication, is increasing. Antiretroviral therapy has improved the life expectancy of HIV-infected kidney transplant recipients. In Japan, discrimination and prejudice against HIV persist, and few kidney transplants are performed. We report three cases in which kidney transplantation was smoothly performed with multidisciplinary collaboration.
Case presentation
The first case involved a 29-year-old male urgently hospitalized due to severe kidney dysfunction, diagnosed with HIV-associated nephropathy (HIVAN), and placed on maintenance dialysis. The patient was administered oral lamivudine, abacavir, and raltegravir as ART and underwent blood group-matched living donor kidney transplantation at age 32. The second case involved a 49-year-old male diagnosed as HIV-positive at age 33 and placed on maintenance dialysis for HIVAN at age 47. Darunavir, ritonavir, and dolutegravir (DTG) were initially administered. However, the ART was switched to rilpivirine (RPV) and DTG prior to kidney transplantation because of potential ART interactions with calcineurin inhibitors. The patient underwent blood group-matched living donor kidney transplantation. The third case involved a 41-year-old male diagnosed as HIV-positive at 23 years old and treated with RPV and DTG. Due to autosomal dominant polycystic kidney disease (ADPKD), his kidney function gradually worsened, and he was started on hemodialysis. He underwent hemodialysis, followed by blood type-matched living donor kidney transplantation. In all cases, transplant physicians, nephrologists, infectious disease physicians, hepatologists, nurses, pharmacists, nutritionists, and clinical psychologists collaborated to discuss and share medical problems and sociopsychological backgrounds of the patients. There was no rejection, CD4+ lymphocyte counts were maintained, and there was no increase in viral load post-surgery. Information sharing among various departments has continued post-surgery, kidney function has improved, and no increase in viral load has been identified on follow-up.
Conclusions
Kidney transplantation is the kidney replacement therapy of choice for HIV-infected patients with CKD. Specialized support is required for kidney transplantation, including coordinating immunosuppressive therapy to avoid rejection, learning about drug interactions, and providing sociopsychological support. Multidisciplinary collaboration is important to ensure safe and smooth kidney transplantation care for HIV-infected patients.
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Rozera G, Visco-Comandini U, Giombini E, Santini F, Forbici F, Berno G, Gruber C, De Paolis P, Colonnelli R, D'Offizi G, Ettorre GM, Grossi P, Capobianchi MR, Ippolito G, Abbate I. Analysis of HIV quasispecies and virological outcome of an HIV D+/R+ kidney-liver transplantation. Virol J 2022; 19:4. [PMID: 34991646 PMCID: PMC8739652 DOI: 10.1186/s12985-021-01730-w] [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: 09/03/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Transplantation among HIV positive patients may be a valuable therapeutic intervention. This study involves an HIV D+/R+ kidney-liver transplantation, where PBMC-associated HIV quasispecies were analyzed in donor and transplant recipients (TR) prior to transplantation and thereafter, together with standard viral monitoring. METHODS The donor was a 54 year of age HIV infected woman: kidney and liver recipients were two HIV infected men, aged 49 and 61. HIV quasispecies in PBMC was analyzed by ultra-deep sequencing of V3 env region. During TR follow-up, plasma HIV-1 RNA, HIV-1 DNA in PBMC, analysis of proviral integration sites and drug-resistance genotyping were performed. Other virological and immunological monitoring included CMV and EBV DNA quantification in blood and CD4 T cell counts. RESULTS Donor and TR were all ART-HIV suppressed at transplantation. Thereafter, TR maintained a nearly suppressed HIV-1 viremia, but HIV-1 RNA blips and the increase of proviral integration sites in PBMC attested some residual HIV replication. A transient peak in HIV-1 DNA occurred in the liver recipient. No major changes of drug-resistance genotype were detected after transplantation. CMV and EBV transient reactivations were observed only in the kidney recipient, but did not require specific treatment. CD4 counts remained stable. No intermixed quasispecies between donor and TR was observed at transplantation or thereafter. Despite signs of viral evolution in TR, HIV genetic heterogeneity did not increase over the course of the months of follow up. CONCLUSIONS No evidence of HIV superinfection was observed in the donor nor in the recipients. The immunosuppressive treatment administrated to TR did not result in clinical relevant viral reactivations.
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Affiliation(s)
- Gabriella Rozera
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy.
| | | | - Emanuela Giombini
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy
| | - Francesco Santini
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy
| | - Federica Forbici
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy
| | - Giulia Berno
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy
| | - Cesare Gruber
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy
| | - Paolo De Paolis
- Nefrology Unit, P.O.I.T. San Camillo-Spallanzani, Rome, Italy
| | | | | | | | | | - Maria Rosaria Capobianchi
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy
| | - Giuseppe Ippolito
- Scientific Direction, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Rome, Italy
| | - Isabella Abbate
- Virology Unit, National Institute for Infectious Diseases, I.R.C.C.S. L.Spallanzani, Via Portuense, 292, 00149, Rome, Italy
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Durand CM, Zhang W, Brown DM, Yu S, Desai N, Redd AD, Bagnasco SM, Naqvi FF, Seaman S, Doby BL, Ostrander D, Bowring MG, Eby Y, Fernandez RE, Friedman-Moraco R, Turgeon N, Stock P, Chin-Hong P, Mehta S, Stosor V, Small CB, Gupta G, Mehta SA, Wolfe CR, Husson J, Gilbert A, Cooper M, Adebiyi O, Agarwal A, Muller E, Quinn TC, Odim J, Huprikar S, Florman S, Massie AB, Tobian AAR, Segev DL. A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action. Am J Transplant 2021; 21:1754-1764. [PMID: 32701209 PMCID: PMC8073960 DOI: 10.1111/ajt.16205] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
HIV-positive donor to HIV-positive recipient (HIV D+/R+) transplantation is permitted in the United States under the HIV Organ Policy Equity Act. To explore safety and the risk attributable to an HIV+ donor, we performed a prospective multicenter pilot study comparing HIV D+/R+ vs HIV-negative donor to HIV+ recipient (HIV D-/R+) kidney transplantation (KT). From 3/2016 to 7/2019 at 14 centers, there were 75 HIV+ KTs: 25 D+ and 50 D- (22 recipients from D- with false positive HIV tests). Median follow-up was 1.7 years. There were no deaths nor differences in 1-year graft survival (91% D+ vs 92% D-, P = .9), 1-year mean estimated glomerular filtration rate (63 mL/min D+ vs 57 mL/min D-, P = .31), HIV breakthrough (4% D+ vs 6% D-, P > .99), infectious hospitalizations (28% vs 26%, P = .85), or opportunistic infections (16% vs 12%, P = .72). One-year rejection was higher for D+ recipients (50% vs 29%, HR: 1.83, 95% CI 0.84-3.95, P = .13) but did not reach statistical significance; rejection was lower with lymphocyte-depleting induction (21% vs 44%, HR: 0.33, 95% CI 0.21-0.87, P = .03). In this multicenter pilot study directly comparing HIV D+/R+ with HIV D-/R+ KT, overall transplant and HIV outcomes were excellent; a trend toward higher rejection with D+ raises concerns that merit further investigation.
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Affiliation(s)
- Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wanying Zhang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane M. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Niraj Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Serena M. Bagnasco
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fizza F. Naqvi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shanti Seaman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brianna L. Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reinaldo E. Fernandez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Friedman-Moraco
- Department of Medicine, Emory University, Atlanta, Georgia
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Nicole Turgeon
- Department of Surgery, Emory University, Atlanta, Georgia
- Department of Surgery, Dell Medical School, University of Texas, Austin, Texas
| | - Peter Stock
- Department of Medicine, University of California, San Francisco, California
| | - Peter Chin-Hong
- Department of Medicine, University of California, San Francisco, California
| | - Shikha Mehta
- Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Valentina Stosor
- Department of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine B. Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Gaurav Gupta
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Sapna A. Mehta
- NYU Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York
| | - Cameron R. Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Husson
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alexander Gilbert
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia
| | - Oluwafisayo Adebiyi
- Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana
| | - Avinash Agarwal
- Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Elmi Muller
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jonah Odim
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Shirish Huprikar
- Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York
| | - Sander Florman
- Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Jespersen NA, Axelsen F, Dollerup J, Nørgaard M, Larsen CS. The burden of non-communicable diseases and mortality in people living with HIV (PLHIV) in the pre-, early- and late-HAART era. HIV Med 2021; 22:478-490. [PMID: 33645000 PMCID: PMC8247855 DOI: 10.1111/hiv.13077] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
Objectives To estimate the burden of non‐communicable diseases (NCDs) and mortality among PLHIV in the pre‐, early‐ and late‐HAART (highly active antiretroviral therapy) era. Methods We conducted a cohort study using population‐based Danish medical registries including all adult HIV‐infected residents of the Central Denmark Region during 1985–2017. For each HIV patient, we selected 10 comparisons from the background population matched by age, sex and municipality of residence. Based on hospital‐related diagnoses we estimated the prevalence and incidence of specific NCD at diagnosis and at 5 and 10 years. Results We identified 1043 PLHIV and 10 430 matched comparisons. PLHIV had lower socioeconomic status and more were born outside western Europe. At HIV diagnosis, 21.9% of PHLIV vs. 18.2% of non‐HIV individuals had at least one NCD, increasing to 42.2% vs. 25.9% after 10 years. PLHIV had higher prevalence and cumulative incidence of alcohol abuse, chronic obstructive pulmonary disease (COPD), ischaemic heart disease, mental disorders, renal and liver disease, but no increased risk of diabetes mellitus. Only PLHIV in the age groups 41–50 and > 51 years had an increased incidence of osteoporosis. From the pre‐ to the late‐HAART era, 10‐year mortality among PLHIV decreased from 45.5% to 9.4% but continued at more than twice that of uninfected comparisons. However, in the late‐HAART era, the mortality of PLHIV who were alive 2 years after HIV diagnosis was approaching that of comparisons. Conclusions Even in the late‐HAART era, PLHIV have an excess mortality, which may be attributable to several NCDs being more prevalent among PLHIV. The prevalence rates of ischaemic heart disease, diabetes, osteoporosis and renal disease tend to increase over calendar time. Therefore, improvement of survival and quality of life of PLHIV neets strategies to reduce the risk of developing NCDs, including avoiding toxic antiretroviral therapy and lifestyle changes.
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Affiliation(s)
- N A Jespersen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - F Axelsen
- Gilead Sciences Denmark, Copenhagen S, Denmark
| | - J Dollerup
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - C S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
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Nel JS, Conradie F, Botha J, Etheredge H, Fabian J, Levin L, Mazanderani AH, Moorhouse M, Muller E, Tiemessen C, Thomson D, Turner J. Southern African HIV Clinicians Society guidelines for solid organ transplantation in human immunodeficiency virus: An evidence-based framework for human immunodeficiency virus-positive donors and recipients. South Afr J HIV Med 2020; 21:1133. [PMID: 33240537 PMCID: PMC7670031 DOI: 10.4102/sajhivmed.v21i1.1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeremy S Nel
- Helen Joseph Hospital, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesca Conradie
- Clinical HIV Research Unit, Wits Health Consortium, Johannesburg, South Africa.,Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Helen Joseph Hospital, Johannesburg, South Africa
| | - Jean Botha
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | | | - June Fabian
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa.,Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Leon Levin
- Helen Joseph Hospital, Johannesburg, South Africa.,Right to Care, NGO, Johannesburg, South Africa
| | - Ahmad H Mazanderani
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Elmi Muller
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Caroline Tiemessen
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,DST/NRF Chair of HIV Vaccine Translational Research, Pretoria, South Africa
| | - David Thomson
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Guo H, Liu J, Pu L, Hao J, Yin N, Liu Y, Xiong H, Li A. Continuous renal replacement therapy in patients with HIV/AIDS. BMC Nephrol 2020; 21:95. [PMID: 32160882 PMCID: PMC7066780 DOI: 10.1186/s12882-020-01754-4] [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: 12/17/2019] [Accepted: 02/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis. Methods We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study. Results 122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR = 7.333,95% CI 1.467–36.664, p = 0.015), higher likelihood of diagnosis for septic shock (OR = 1.005,95% CI 1.001–1.01, p = 0.018), and higher likelihood to use vasoactive agents (OR = 10.667,95% CI 1.743–65.271, p = 0.001), longer mechanical ventilation duration (OR = 1.011,95% CI 1.002–1.019, p = 0.011), higher likelihood for diagnosis for PCP (OR = 7.50,95% CI 1.288–43.687, p = 0.025), higher SOFA score at ICU admission (OR = 1.183,95% CI 1.012–1.383, p = 0.035), longer duration of CRRT (OR = 1.014,95% CI 1.001–1.028, p = 0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p = 0.595). Conclusions There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.
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Affiliation(s)
- Hebing Guo
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Jingyuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Lin Pu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Jingjing Hao
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Ningning Yin
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Yufeng Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Haofeng Xiong
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Ang Li
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China.
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11
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Back D, Marzolini C. The challenge of HIV treatment in an era of polypharmacy. J Int AIDS Soc 2020; 23:e25449. [PMID: 32011104 PMCID: PMC6996317 DOI: 10.1002/jia2.25449] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age-related comorbidities resulting in complex polypharmacy and an increased risk for drug-drug interactions. Furthermore, age-related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug-drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug-disease interaction) encountered in elderly PLWH. DISCUSSION Prescribing issues are common in elderly PLWH due to the presence of age-related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug-drug interactions, drugs dosage errors and inappropriate drug use. CONCLUSIONS The high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient.
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Affiliation(s)
- David Back
- Department of Molecular and Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Catia Marzolini
- Department of Molecular and Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
- Division of Infectious Diseases and Hospital EpidemiologyDepartments of Medicine and Clinical ResearchUniversity Hospital of Basel and University of BaselBaselSwitzerland
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12
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Ando M, Ando Y. A high likelihood of increase in end-stage renal disease among the Japanese HIV-infected population. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0245-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractKidneys are affected by human immunodeficiency virus (HIV) infection and its associated therapies. Antiretroviral therapy (ART) has markedly reduced acquired immune deficiency syndrome–related deaths and opportunistic infectious diseases among HIV-infected patients. This contributed to their prolonged survival; however, the improvement in survival has been accompanied by an increase in the incidence of non-infectious chronic complications, including hypertension, metabolic diseases, and chronic kidney disease (CKD). Recent studies showed that estimated prevalence of any CKD and end-stage renal disease (ESRD) among HIV-infected patients is approximately 20% and 0.5%, respectively, in Japan. Both a rapid decrease in renal function and a high positive rate of albuminuria and proteinuria are clinical characteristics of HIV-infected patients. Moreover, considering higher complication rates of hypertension and diabetes compared with non-HIV-infected individuals of the similar aging, HIV-infected patients who develop CKD and ESRD are very likely to increase. Furthermore, as the survival rate is favorable after the initiation of dialysis, the cumulative number of ESRD patients is supposed to increase. The corporation for treatment of HIV-positive hemodialysis patients by general dialysis clinics will be urgently required; however, there still remain some preoccupations and prejudices about HIVper sein Japan, which may provoke hesitation from accepting those patients.
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13
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Pontes PS, Melo ES, Costa CRB, Antonini M, Sousa LRM, Gir E, Reis RK. Estimativa da taxa de filtração glomerular em pessoas vivendo com HIV. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Avaliar os fatores associados à estimativa da Taxa de Filtração Glomerular (eTFG) em pessoas vivendo com HIV. Métodos Estudo transversal e analítico, com avaliação de 340 pessoas em atendimento ambulatorial no município de Ribeirão Preto-SP. Calculou-se a eTFG através da fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Foi realizado análise univariada com os testes Qui-quadrado e Exato de Fisher, com p<0,05. Resultados Identificou que 114 (34,1%) dos participantes apresentaram alterações na Filtração Glomerular, dos quais (90) 27,5% foram classificadas em estágio 2, 15 (4,5%) em estágio 3A e 07 (2,1%) em estágio 3B. Conclusão O estudo evidenciou que as variáveis sexo, idade, hipertensão, diabetes, IMC e tempo de diagnóstico apresentaram associação com a Taxa de Filtração Glomerular. Ressalta-se a importância do acompanhamento integral de PVHIV para a tomada de decisões de modo a prevenir a ocorrência de disfunções renais.
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14
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Abstract
Introduction: Combined antiretroviral therapy has transformed HIV infection into a chronic disease thus people living with HIV (PLWH) live longer. As a result, the management of HIV infection is becoming more challenging as elderly experience age-related comorbidities leading to complex polypharmacy and a higher risk for drug-drug or drug-disease interactions. Furthermore, age-related physiological changes affect pharmacokinetics and pharmacodynamics thereby predisposing elderly PLWH to incorrect dosing or inappropriate prescribing and consequently to adverse drug reactions and the subsequent risk of starting a prescribing cascade. Areas covered: This review discusses the demographics of the aging HIV population, physiological changes and their impact on drug response as well as comorbidities. Particular emphasis is placed on common prescribing issues in elderly PLWH including drug-drug interactions with antiretroviral drugs. A PubMed search was used to compile relevant publications until February 2019. Expert opinion: Prescribing issues are highly prevalent in elderly PLWH thus highlighting the need for education on geriatric prescribing principles. Adverse health outcomes potentially associated with polypharmacy and inappropriate prescribing should promote interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits for a given patient. A multidisciplinary team approach is recommended for the care of elderly PLWH.
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Affiliation(s)
- Catia Marzolini
- a Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital of Basel and University of Basel , Basel , Switzerland.,b Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool , UK
| | - Françoise Livio
- c Service of Clinical Pharmacology, Department of Laboratories , University Hospital of Lausanne , Lausanne , Switzerland
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15
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Werbel WA, Durand CM. Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers. Curr HIV/AIDS Rep 2019; 16:191-203. [PMID: 31093920 PMCID: PMC6579039 DOI: 10.1007/s11904-019-00440-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW End-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers. RECENT FINDINGS HIV+ recipients historically experienced 2-4-fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation. SOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients; however, strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.
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Affiliation(s)
- William A. Werbel
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
- Sidney Kimmel Cancer Center, Johns Hopkins University
School of Medicine, Baltimore, MD
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16
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Bayraktar A, Dirim AB, Bakkaloglu H, Kaan Gok AF, Demir E, Ucar AR, Turkmen A, Aydin AE. Deceased Donor Kidney Transplantation in a Human Immunodeficiency Virus-Infected Recipient: A Case Report. Transplant Proc 2019; 51:1187-1189. [PMID: 31101197 DOI: 10.1016/j.transproceed.2019.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
Abstract
Human immunodeficiency virus (HIV) infection has traditionally been considered an absolute contraindication for transplantation because immunosuppression will accelerate the disease progression and increase mortality. New antiretroviral agents have given rise to new perspectives and transplantation practices. Now renal transplantation is the gold standard treatment for end-stage renal disease in HIV-infected patients, but increased rejection and toxicity rates and compliance with treatment are important issues. Therefore, patient selection and follow-up should be done carefully in this patient group. Here we present a 51-year-old, male, HIV-infected patient who was diagnosed with HIV at his routine serologic investigation at 2015. Highly active antiretroviral therapy was initiated. One haplotype-matched kidney transplantation from a deceased donor was performed on October 19, 2016. Induction therapy was not administered, and the immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisolone. After 26 months, serum creatinine was 1.1 mg/dL and proteinuria 0.1 g/day. There was no development of donor-specific antibodies. The patient's current HIV viral load remains undetectable (and had been the entire time post-transplantation) while his CD4+ T-cell count currently is 543/mm3.
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Affiliation(s)
- A Bayraktar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A B Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - H Bakkaloglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A F Kaan Gok
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - E Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - A R Ucar
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A E Aydin
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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17
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Yoshifuji A, Ryuzaki M, Ito Y, Ohmagari N, Kanno Y, Shinoda T, Takano Y, Tsukamoto I, Hora K, Nakazawa Y, Hasegawa N, Yoshida T, Wakino S, Takemoto Y, Nakamoto H. Acceptance situation of HIV patients in Japanese dialysis facilities—questionnaire survey by the Infection Survey Subcommittee. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Ahlström MG, Knudsen A, Ullum H, Gerstoft J, Kjaer A, Lebech AM, Hasbak P, Obel N. Association between smoking status assessed with plasma-cotinine and inflammatory and endothelial biomarkers in HIV-positive and HIV-negative individuals. HIV Med 2018; 19:679-687. [DOI: 10.1111/hiv.12647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- MG Ahlström
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - A Knudsen
- Department of Infectious Diseases; Copenhagen University Hospital; Hvidovre Denmark
| | - H Ullum
- Department of Clinical Immunology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - J Gerstoft
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - A Kjaer
- Department of Nuclear Physiology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - A-M Lebech
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - P Hasbak
- Department of Nuclear Physiology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - N Obel
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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19
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Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA, Atta MG. HIV-associated nephropathy: links, risks and management. HIV AIDS (Auckl) 2018; 10:73-81. [PMID: 29872351 PMCID: PMC5975615 DOI: 10.2147/hiv.s141978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Despite the decreased incidence of human immunodeficiency virus (HIV)-associated nephropathy due to the widespread use of combined active antiretroviral therapy, it remains one of the leading causes of end-stage renal disease (ESRD) in HIV-1 seropositive patients. Patients usually present with low CD4 count, high viral load and heavy proteinuria, with the pathologic findings of collapsing focal segmental glomerulosclerosis. Increased susceptibility exists in individuals with African descent, largely due to polymorphism in APOL1 gene. Other clinical risk factors include high viral load and low CD4 count. Advanced kidney disease and nephrotic range proteinuria have been associated with progression to ESRD. Improvement in kidney function has been observed after initiation of combined active antiretroviral therapy. Other treatment options, when clinically indicated, are inhibition of the renin-angiotensin system and corticosteroids. Further routine management approaches for patients with chronic kidney disease should be implemented. In patients with progression to ESRD, kidney transplant should be pursued, provided that viral load control is adequate. Screening for the presence of kidney disease upon detection of HIV-1 seropositivity in high-risk populations is recommended.
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Affiliation(s)
- Laura Palau
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven Menez
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Tessa Novick
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marco Delsante
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Blaithin A McMahon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mohamed G Atta
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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20
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Hjalte F, Calara PS, Blaxhult A, Helleberg M, Wallace K, Lindgren P. Excess costs of non-infectious comorbidities among people living with HIV - estimates from Denmark and Sweden. AIDS Care 2018; 30:1090-1098. [PMID: 29774749 DOI: 10.1080/09540121.2018.1476661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People living with HIV have an increased risk of comorbidities with non-communicable diseases such as cardiovascular disease, chronic kidney disease and osteoporotic fractures, compared to the general population. The burden of these comorbidities is expected to rise as the HIV-infected population ages. This development may require additional health care resources and it is relevant to ascertain the costs associated with these comorbidities. The population attributed risk approach was applied to estimate excess costs associated with the higher rates of comorbidities among HIV patients in Denmark and Sweden compared to their respective general populations. Excess direct and indirect costs for one year were calculated for myocardial infarction, stroke, osteoporotic fractures and chronic kidney disease. Cost estimates were presented in age and sex subgroups. In the course of one year the excess costs for myocardial infarction, stroke, osteoporotic fractures and chronic kidney disease attributable to HIV was estimated to €3.4 million for Denmark and €2.6 million for Sweden. Chronic kidney disease accounted for the majority of the total excess costs, followed by osteoporotic fractures, myocardial infarction and stroke. The high prevalence of comorbidities in the HIV-infected population is associated with substantial excess costs. Focus on primary and secondary prophylactic interventions is warranted. Additional studies, preferably large-scale case-control studies, may give further insights on the extent and the predictors of these excess costs.
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Affiliation(s)
- Frida Hjalte
- a The Swedish Institute for Health Economics (IHE) , Lund , Sweden
| | - Paul S Calara
- a The Swedish Institute for Health Economics (IHE) , Lund , Sweden
| | - Anders Blaxhult
- b Department of Infectious Diseases , Venhälsan, Södersjukhuset , Stockholm , Sweden
| | - Marie Helleberg
- c Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | | | - Peter Lindgren
- a The Swedish Institute for Health Economics (IHE) , Lund , Sweden.,e Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden
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21
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Kooij KW, Vogt L, Wit FWNM, van der Valk M, van Zoest RA, Goorhuis A, Prins M, Post FA, Reiss P. Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls. J Infect Dis 2017; 216:622-631. [PMID: 28934420 DOI: 10.1093/infdis/jix202] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/07/2017] [Indexed: 01/22/2023] Open
Abstract
Background Human immunodeficiency virus (HIV)-infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute. Methods We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2), albuminuria (albumin/creatinine ratio ≥3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93μg/mmol and/or fractional phosphate excretion >20% with plasma phosphate <0.8 mmol/L) in 596 HIV-infected and 544 HIV-uninfected AGEhIV Cohort Study participants. We also assessed whether being HIV-infected on cART, with follow-up censored when cART regimen was modified, was associated with greater eGFR decline or worsening albuminuria (increase ≥10%/year with change in albuminuria category). Results Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0-4.4), albuminuria (aOR = 5.8; 95% CI = 3.7-9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9-10.2]). Among 377 HIV-infected and 479 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (-0.56; 95% CI = -0.87 to -0.24 mL/min/1.73m2/year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3-4.0). Conclusions In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus-infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.
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Affiliation(s)
- Katherine W Kooij
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Liffert Vogt
- Department of Nephrology, Academic Medical Center
| | - Ferdinand W N M Wit
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development.,Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center.,HIV Monitoring Foundation
| | - Marc van der Valk
- Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center
| | - Rosan A van Zoest
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Abraham Goorhuis
- Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center
| | - Maria Prins
- Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center.,Public Health Service Amsterdam, Infectious Diseases Research, Amsterdam, the Netherlands
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter Reiss
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development.,Division of Infectious Diseases and Center for Infection and Immunity Amsterdam, Academic Medical Center.,HIV Monitoring Foundation
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22
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Diana NE, Naicker S. Update on current management of chronic kidney disease in patients with HIV infection. Int J Nephrol Renovasc Dis 2016; 9:223-234. [PMID: 27695357 PMCID: PMC5033612 DOI: 10.2147/ijnrd.s93887] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN). However, the prevalence of end-stage renal disease in HIV-positive individuals has risen, mainly due to increased longevity on cART. There is a disparity in the occurrence of HIVAN among HIV-positive individuals such that there is an 18- to 50-fold increased risk of developing kidney disease among HIV-positive individuals of African descent aged between 20 and 64 years and who have a poorer prognosis compared with their European descent counterparts, suggesting that genetic factors play a vital role. Other risk factors include male sex, low CD4 counts, and high viral load. Improvement in renal function has been observed after initiation of cART in patients with HIV-associated CKD. Treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker is recommended, when clinically indicated in patients with confirmed or suspected HIVAN or clinically significant albuminuria. Other standard management approaches for patients with CKD are recommended. These include addressing other cardiovascular risk factors (appropriate use of statins and aspirin, weight loss, cessation of smoking), avoidance of nephrotoxins, and management of serum bicarbonate and uric acid, anemia, calcium, and phosphate abnormalities. Early diagnosis of kidney disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended.
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Affiliation(s)
- Nina E Diana
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Urinary Markers of Tubular Injury in HIV-Infected Patients. Biochem Res Int 2016; 2016:1501785. [PMID: 27493802 PMCID: PMC4967446 DOI: 10.1155/2016/1501785] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality. Early and accurate identification of renal disease is therefore crucial to improve patient outcomes. The use of serum creatinine, along with proteinuria, to detect renal involvement is essentially to screen for markers of glomerular disease and may not be effective in detecting earlier stages of renal injury. Therefore, more sensitive and specific markers are needed in order to early identify HIV-infected patients at risk of renal disease. This review article summarizes some new and important urinary markers of tubular injury in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients.
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Serrano-Villar S, Gutiérrez F, Miralles C, Berenguer J, Rivero A, Martínez E, Moreno S. Human Immunodeficiency Virus as a Chronic Disease: Evaluation and Management of Nonacquired Immune Deficiency Syndrome-Defining Conditions. Open Forum Infect Dis 2016; 3:ofw097. [PMID: 27419169 PMCID: PMC4943534 DOI: 10.1093/ofid/ofw097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/29/2016] [Indexed: 12/17/2022] Open
Abstract
In the modern antiretroviral therapy (ART) era, motivated people living with human immunodeficiency virus (HIV) who have access to therapy are expected to maintain viral suppression indefinitely and to receive treatment for decades. Hence, the current clinical scenario has dramatically shifted since the early 1980s, from treatment and prevention of opportunistic infections and palliative care to a new scenario in which most HIV specialists focus on HIV primary care, ie, the follow up of stable patients, surveillance of long-term toxicities, and screening and prevention of age-related conditions. The median age of HIV-infected adults on ART is progressively increasing. By 2030, 3 of every 4 patients are expected to be aged 50 years or older in many countries, more than 80% will have at least 1 age-related disease, and approximately one third will have at least 3 age-related diseases. Contemporary care of HIV-infected patients is evolving, and questions about how we might monitor and perhaps even treat HIV-infected adults have emerged. Through key published works, this review briefly describes the most prevalent comorbidities and age-associated conditions and highlights the differential features in the HIV-infected population. We also discuss the most critical aspects to be considered in the care of patients with HIV for the management and prevention of age-associated disease.
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Affiliation(s)
- Sergio Serrano-Villar
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
| | - Félix Gutiérrez
- Hospital Universitario de Elche and Universidad Miguel Hernández , Alicante
| | | | - Juan Berenguer
- Juan Berenguer , Hospital Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón , Madrid
| | - Antonio Rivero
- Unidad de Gestión Clínica Enfermedades Infecciosas , Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica de Córdoba
| | - Esteban Martínez
- Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona , Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
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Glindvad Ahlstrom M, Feldt-Rasmussen B, Gerstoft J, Obel N. Routine urine protein/creatinine ratio testing in an outpatient setting of Danish HIV-infected individuals. Infect Dis (Lond) 2016; 48:560-2. [PMID: 26950430 DOI: 10.3109/23744235.2016.1154600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Bo Feldt-Rasmussen
- b Department of Nephrology , Copenhagen University Hospital , Rigshospitalet , Denmark
| | - Jan Gerstoft
- a Department of Infectious Diseases , Copenhagen University Hospital , Rigshospitalet , Denmark ;,c Faculty of Health Sciences , University of Copenhagen , Denmark
| | - Niels Obel
- a Department of Infectious Diseases , Copenhagen University Hospital , Rigshospitalet , Denmark ;,c Faculty of Health Sciences , University of Copenhagen , Denmark
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Achhra AC, Mocroft A, Ross MJ, Ryom L, Lucas GM, Furrer H, Neuhaus J, Somboonwit C, Kelly M, Gatell JM, Wyatt CM. Kidney disease in antiretroviral-naïve HIV-positive adults with high CD4 counts: prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:55-63. [PMID: 25711324 DOI: 10.1111/hiv.12234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES HIV infection has been associated with an increased risk of chronic kidney disease (CKD). Little is known about the prevalence of CKD in individuals with high CD4 cell counts prior to initiation of antiretroviral therapy (ART). We sought to address this knowledge gap. METHODS We describe the prevalence of CKD among 4637 ART-naïve adults (mean age 36.8 years) with CD4 cell counts > 500 cells/μL at enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. CKD was defined by estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) and/or dipstick urine protein ≥ 1+. Logistic regression was used to identify baseline characteristics associated with CKD. RESULTS Among 286 [6.2%; 95% confidence interval (CI) 5.5%, 6.9%] participants with CKD, the majority had isolated proteinuria. A total of 268 participants had urine protein ≥ 1+, including 41 with urine protein ≥ 2+. Only 22 participants (0.5%) had an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) , including four who also had proteinuria. Baseline characteristics independently associated with CKD included diabetes [adjusted odds ratio (aOR) 1.73; 95% CI 1.05, 2.85], hypertension (aOR 1.82; 95% CI 1.38, 2.38), and race/ethnicity (aOR 0.59; 95% CI 0.37, 0.93 for Hispanic vs. white). CONCLUSIONS We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-naïve clinical trial participants with CD4 cell counts > 500 cells/μL.
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Affiliation(s)
- A C Achhra
- Kirby Institute, University of New South Wales, Sydney, Australia
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Ahlström MG, Feldt-Rasmussen B, Legarth R, Kronborg G, Pedersen C, Larsen CS, Gerstoft J, Obel N. Smoking and renal function in people living with human immunodeficiency virus: a Danish nationwide cohort study. Clin Epidemiol 2015; 7:391-9. [PMID: 26357490 PMCID: PMC4559253 DOI: 10.2147/clep.s83530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Smoking is a main risk factor for morbidity and mortality in people living with human immunodeficiency virus (PLHIV), but its potential association with renal impairment remains to be established. METHODS We did a nationwide population-based cohort study in Danish PLHIV to evaluate the association between smoking status and 1) overall renal function and risk of chronic kidney disease (CKD), 2) risk of any renal replacement therapy (aRRT), and 3) mortality following aRRT. We calculated estimated creatinine clearance using the Cockcroft-Gault equation (CG-CrCl), and evaluated renal function graphically. We calculated cumulative incidence of CKD (defined as two consecutive CG-CrCls of ≤60 mL/min, ≥3 months apart) and aRRT and used Cox regression models to calculate incidence rate ratios (IRRs) for risk of CKD, aRRT, and mortality rate ratios (MRRs) following aRRT. RESULTS From the Danish HIV Cohort Study, we identified 1,475 never smokers, 768 previous smokers, and 2,272 current smokers. During study period, we observed no association of smoking status with overall renal function. Previous and current smoking was not associated with increased risk of CKD (adjusted IRR: 1.1, 95% confidence interval [CI]: 0.7-1.7; adjusted IRR: 1.3, 95% CI: 0.9-1.8) or aRRT (adjusted IRR: 0.8, 95% CI: 0.4-1.7; adjusted IRR: 0.9, 95% CI: 0.5-1.7). Mortality following aRRT was high in PLHIV and increased in smokers vs never smokers (adjusted MRR: 3.8, 95% CI: 1.3-11.2). CONCLUSION In Danish PLHIV, we observed no strong association between smoking status and renal function, risk of CKD, or risk of aRRT, but mortality was increased in smokers following aRRT.
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Affiliation(s)
- Magnus Glindvad Ahlström
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rebecca Legarth
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Carsten Schade Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Rasmussen LD, May MT, Kronborg G, Larsen CS, Pedersen C, Gerstoft J, Obel N. Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study. Lancet HIV 2015; 2:e288-98. [PMID: 26423253 DOI: 10.1016/s2352-3018(15)00077-6] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/15/2015] [Accepted: 04/21/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Whether the reported high risk of age-related diseases in HIV-infected people is caused by biological ageing or HIV-associated risk factors such as chronic immune activation and low-grade inflammation is unknown. We assessed time trends in age-standardised and relative risks of nine serious age-related diseases in a nationwide cohort study of HIV-infected individuals and population controls. METHODS We identified all HIV-infected individuals in the Danish HIV Cohort Study who had received HIV care in Denmark between Jan 1, 1995, and June 1, 2014. Population controls were identified from the Danish Civil Registration System and individually matched in a ratio of nine to one to the HIV-infected individuals for year of birth, sex, and date of study inclusion. Individuals were included in the study if they had a Danish personal identification number, were aged 16 years or older, and were living in Denmark at the time of study inclusion. Data for study outcomes were obtained from the Danish National Hospital Registry and the Danish National Registry of Causes of Death and were cardiovascular diseases (myocardial infarction and stroke), cancers (virus associated, smoking related, and other), severe neurocognitive disease, chronic kidney disease, chronic liver disease, and osteoporotic fractures. We calculated excess and age-standardised incidence rates and adjusted incidence rate ratios of outcomes for time after HIV diagnosis, highly active antiretroviral therapy (ART) initiation, and calendar time. The regression analyses were adjusted for age, sex, calendar time, and origin. FINDINGS We identified 5897 HIV-infected individuals and 53,073 population controls; median age was 36·8 years (IQR 30·6-44·4), and 76% were men in both cohorts. Dependent on disease, the HIV cohort had 55,050-57,631 person-years of follow-up and the population controls had 638,204-659,237 person-years of follow-up. Compared with the population controls, people with HIV had high excess and relative risk of all age-related diseases except other cancers. Overall, the age-standardised and relative risks of cardiovascular diseases, cancers, and severe neurocognitive disease did not increase substantially with time after HIV diagnosis or ART initiation. Except for chronic kidney diseases, the age-standardised and relative risks of age-related diseases did not increase with calendar time. INTERPRETATIONS Severe age-related diseases are highly prevalent in people with HIV, and continued attention and strategies for risk reduction are needed. The findings from our study do not suggest that accelerated ageing is a major problem in the HIV-infected population. FUNDING Preben og Anna Simonsens Fond, Novo Nordisk Foundation, Danish AIDS Foundation, Augustinus Foundation, and Odense University Hospitals Frie Fonds Midler.
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Affiliation(s)
- Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Carsten S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Yombi JC, Jones R, Pozniak A, Hougardy JM, Post FA. Monitoring of kidney function in HIV-positive patients. HIV Med 2015; 16:457-67. [PMID: 25944246 DOI: 10.1111/hiv.12249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 01/11/2023]
Abstract
HIV-positive patients are at increased risk of developing chronic kidney disease. Although guidelines recommend regular monitoring of renal function in individuals living with HIV, the optimal frequency remains to be defined. In this review, we discuss the renal syndromes that may be identified at an earlier stage via routine assessment of kidney function, and provide guidance in terms of the frequency of monitoring, the most useful tests to perform, and their clinical significance. Specifically, we address whether annual monitoring of kidney function is appropriate for the majority of HIV-positive patients.
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Affiliation(s)
- J C Yombi
- AIDS Reference Centre, St Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - R Jones
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - A Pozniak
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - J-M Hougardy
- Nephrology Department, ULB Erasme University Hospital, Brussels, Belgium
| | - F A Post
- King's College Hospital NHS Foundation Trust, London, UK.,King's College London School of Medicine, London, UK
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Richterman A, Blumberg E. The Challenges and Promise of HIV-Infected Donors for Solid Organ Transplantation. Curr Infect Dis Rep 2015; 17:471. [DOI: 10.1007/s11908-015-0471-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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31
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Holt SG, Gracey DM, Levy MT, Mudge DW, Irish AB, Walker RG, Baer R, Sevastos J, Abbas R, Boyd MA. A consensus statement on the renal monitoring of Australian patients receiving tenofovir based antiviral therapy for HIV/HBV infection. AIDS Res Ther 2014; 11:35. [PMID: 25745499 PMCID: PMC4350301 DOI: 10.1186/1742-6405-11-35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/06/2014] [Indexed: 01/05/2023] Open
Abstract
A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus (HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate (TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine and dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment and ongoing monitoring of renal function is an important part of routine management of patients with HIV. Given the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring could be performed in Australian patients on ART regimens, especially those involving TDF. A group of nephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical and reasonable renal management strategies for patients particularly those on TDF-based combination regimens (in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group considered which investigations should be performed as part of routine practice, their frequency, and when specialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with plasma phosphate and an assessment of urinary protein (rather than albumin) and glucose. Here we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g. cobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this value used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly thereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment should be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing protocol may be logical.
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Jotwani V, Scherzer R, Abraham A, Estrella MM, Bennett M, Cohen MH, Nowicki M, Sharma A, Young M, Tien PC, Ix JH, Sarnak MJ, Parikh CR, Shlipak MG. Association of urine α1-microglobulin with kidney function decline and mortality in HIV-infected women. Clin J Am Soc Nephrol 2014; 10:63-73. [PMID: 25370597 DOI: 10.2215/cjn.03220314] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite advances in therapy, HIV-infected individuals remain at higher risk for kidney dysfunction than uninfected individuals. It was hypothesized that urine levels of α1-microglobulin, a biomarker of proximal tubular dysfunction, would predict kidney function decline and mortality risk in HIV-infected and uninfected women. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In the Women's Interagency HIV Study, urine α1-microglobulin and creatinine concentrations were measured in 903 HIV-infected and 287 uninfected women using stored urine from 1999 to 2000, when prevalence of tenofovir use was <1%. Participants were categorized into three categories by level of α1-microglobulin-to-creatinine ratio, and associations with kidney decline and all-cause mortality over 8 years were evaluated. RESULTS Urine α1-microglobulin was detectable in 60% of HIV-infected and 40% of uninfected women (P<0.001). Among HIV-infected women, there were 177 (22%), 61 (7%), and 128 (14%) patients with incident CKD, with 10% annual eGFR decline, and who died, respectively. Compared with HIV-infected women in the lowest α1-microglobulin category, HIV-infected women in the highest α1-microglobulin category had a 2.1-fold risk of incident CKD (95% confidence interval, 1.3 to 3.4), 2.7-fold risk of 10% annual eGFR decline (95% confidence interval, 1.2 to 5.9), and 1.6-fold mortality risk (95% confidence interval, 1.0 to 2.6) in models adjusting for kidney risk factors, baseline eGFR, and albuminuria. Among uninfected women, the highest α1-microglobulin category was associated with 3% (relative risk, 2.2; 95% confidence interval, 1.4 to 3.5) and 5% (relative risk, 2.2; 95% confidence interval, 1.1 to 4.3) annual eGFR decline relative to the lowest α1-microglobulin category. CONCLUSIONS Proximal tubular dysfunction, indicated by urine α1-microglobulin, was independently associated with kidney function decline in HIV-infected and uninfected women and mortality risk among HIV-infected women.
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Affiliation(s)
- Vasantha Jotwani
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Rebecca Scherzer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alison Abraham
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michelle M Estrella
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michael Bennett
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Mardge H Cohen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marek Nowicki
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Anjali Sharma
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Mary Young
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Phyllis C Tien
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Joachim H Ix
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Mark J Sarnak
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Chirag R Parikh
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michael G Shlipak
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
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