1
|
Le Buanec H, Schiavon V, Merandet M, How-Kit A, Song H, Bergerat D, Fombellida-Lopez C, Bensussan A, Bouaziz JD, Burny A, Darcis G, Sajadi MM, Kottilil S, Zagury D, Gallo RC. IFNα induces CCR5 in CD4 + T cells of HIV patients causing pathogenic elevation. COMMUNICATIONS MEDICINE 2024; 4:52. [PMID: 38504093 PMCID: PMC10951336 DOI: 10.1038/s43856-024-00453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Among people living with HIV, elite controllers (ECs) maintain an undetectable viral load, even without receiving anti-HIV therapy. In non-EC patients, this therapy leads to marked improvement, including in immune parameters, but unlike ECs, non-EC patients still require ongoing treatment and experience co-morbidities. In-depth, comprehensive immune analyses comparing EC and treated non-EC patients may reveal subtle, consistent differences. This comparison could clarify whether elevated circulating interferon-alpha (IFNα) promotes widespread immune cell alterations and persists post-therapy, furthering understanding of why non-EC patients continue to need treatment. METHODS Levels of IFNα in HIV-infected EC and treated non-EC patients were compared, along with blood immune cell subset distribution and phenotype, and functional capacities in some cases. In addition, we assessed mechanisms potentially associated with IFNα overload. RESULTS Treatment of non-EC patients results in restoration of IFNα control, followed by marked improvement in distribution numbers, phenotypic profiles of blood immune cells, and functional capacity. These changes still do not lead to EC status, however, and IFNα can induce these changes in normal immune cell counterparts in vitro. Hypothesizing that persistent alterations could arise from inalterable effects of IFNα at infection onset, we verified an IFNα-related mechanism. The protein induces the HIV coreceptor CCR5, boosting HIV infection and reducing the effects of anti-HIV therapies. EC patients may avoid elevated IFNα following on infection with a lower inoculum of HIV or because of some unidentified genetic factor. CONCLUSIONS Early control of IFNα is essential for better prognosis of HIV-infected patients.
Collapse
Affiliation(s)
- Hélène Le Buanec
- Université de Paris; INSERM U976, HIPI Unit, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - Valérie Schiavon
- Université de Paris; INSERM U976, HIPI Unit, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - Marine Merandet
- Université de Paris; INSERM U976, HIPI Unit, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | | | - Hongshuo Song
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - David Bergerat
- Université de Paris; INSERM U976, HIPI Unit, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - Céline Fombellida-Lopez
- Laboratory of Infectious Diseases, GIGA-I3, GIGA-Institute University of Liege, 4000, Liege, Belgium
| | - Armand Bensussan
- Université de Paris; INSERM U976, HIPI Unit, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - Jean-David Bouaziz
- Université de Paris; INSERM U976, HIPI Unit, Institut de Recherche Saint-Louis, F-75010, Paris, France
- Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Arsène Burny
- Laboratory of Molecular Biology, Gembloux Agrobiotech, University of Liège, Liège, Belgium
- Global Virus Network, Baltimore, MD, 21201, USA
| | - Gilles Darcis
- Laboratory of Infectious Diseases, GIGA-I3, GIGA-Institute University of Liege, 4000, Liege, Belgium
| | - Mohammad M Sajadi
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
- Global Virus Network, Baltimore, MD, 21201, USA
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Shyamasundaran Kottilil
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA
- Global Virus Network, Baltimore, MD, 21201, USA
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Program in Oncology, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 21201, USA
| | | | - Robert C Gallo
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD, 21201, USA.
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| |
Collapse
|
2
|
Maggi P, De Socio GV, Menzaghi B, Molteni C, Squillace N, Taramasso L, Guastavigna M, Gamboni G, Madeddu G, Vichi F, Cascio A, Sarchi E, Pellicanò G, Martinelli CV, Celesia BM, Valsecchi L, Gulminetti R, Cenderello G, Parisini A, Calza L, Falasca K, Orofino G, Ricci E, Di Biagio A, Bonfanti P. Growing old with antiretroviral therapy or elderly people in antiretroviral therapy: two different profiles of comorbidity? BMC Infect Dis 2022; 22:745. [PMID: 36151508 PMCID: PMC9508769 DOI: 10.1186/s12879-022-07739-y] [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: 04/07/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background In persons living with HIV (PLWH), the burden of non-communicable chronic diseases increased over time, because of aging associated with chronic inflammation, systemic immune activation, and long-term exposure to the combination antiretroviral therapy (ART). Methods To explore the association of chronological age, age at first ART, and exposure to ART with non-communicable chronic diseases, we performed a cross-sectional analysis to evaluate the prevalence of comorbidities in patients enrolled in the SCOLTA Project, stratified by groups of chronological age (50–59 and 60–69 years) and by years of antiretroviral treatment (ART, ≤ 3 or > 3 years). Results In 1394 subjects (23.8% women), mean age at enrollment was 57.4 (SD 6.5) years, and at first ART 45.3 (SD 10.7). Men were older than women both at enrollment (57.6 vs 56.8, p = 0.06) and at first ART (45.8 vs 43.6, p = 0.0009). ART duration was longer in women (13.1 vs 11.7 years, p = 0.01). The age- and sex-adjusted rate ratios (aRRs, and 95% confidence interval, CI) showed that longer ART exposure was associated with dyslipidemia (aRR 1.35, 95% CI 1.20–1.52), hypertension (aRR 1.52, 95% CI 1.22–1.89), liver disease (aRR 1.78, 95% CI 1.32–2.41), osteopenia/osteoporosis (aRR 2.88, 95% CI 1.65–5.03) and multimorbidity (aRR 1.36, 95% CI 1.21–1.54). These findings were confirmed in strata of age, adjusting for sex. Conclusions Our data suggest that longer ART exposure was associated with increased risk of dyslipidemia, hypertension, and osteopenia/osteoporosis, hence the presence of multimorbidity, possibly due to the exposition to more toxic antiretrovirals. We observed different comorbidities, according to ART exposure and age. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07739-y.
Collapse
Affiliation(s)
- Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Vittorio De Socio
- Clinic of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia, Santa Maria Hospital, Perugia, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Chiara Molteni
- Infectious Disease Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Marta Guastavigna
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Turin, Italy
| | - Giulia Gamboni
- Clinic of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Francesca Vichi
- Infectious Diseases Department, SOC 1, USLCENTRO Firenze, Santa Maria Annunziata Hospital, Florence, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Eleonora Sarchi
- Infectious Diseases Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Giovanni Pellicanò
- Unit of Infectious Diseases, Department of Human Pathology of the Adult and the Developmental Age 'G. Barresi', University of Messina, Messina, Italy
| | | | | | - Laura Valsecchi
- Infectious Disease Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Roberto Gulminetti
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Andrea Parisini
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University 'G. d'Annunzio' Chieti-Pescara, Chieti, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, "Divisione A", Amedeo di Savoia Hospital, Turin, Italy
| | - Elena Ricci
- Fondazione ASIA Onlus, via Garibaldi, 13, 20090, Buccinasco, MI, Italy.
| | - Antonio Di Biagio
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Paolo Bonfanti
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
3
|
Incidence of impaired kidney function among people with HIV: a systematic review and meta-analysis. BMC Nephrol 2022; 23:107. [PMID: 35300612 PMCID: PMC8932163 DOI: 10.1186/s12882-022-02721-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/02/2022] [Indexed: 01/01/2023] Open
Abstract
Background In the era of combination antiretroviral therapy (ART), the incidence, manifestations and severity of kidney diseases have dramatically changed in people living with HIV (PLWH). Little is known about the incidence of impaired kidney function (IKF) measured by serum creatine-based estimated glomerular filtration rate (eGFR) in PLWH. Methods In this systematic review and meta-analysis, we searched PubMed, Ovid, Medline, Embase and Web of Science for studies published before May 7th, 2021, with estimates of incidence of IKF among PLWH. We independently reviewed each study for quality by using the Newcastle-Ottawa scale. The incidence and 95% confidence intervals (CIs) were calculated using random-effects model. Results Sixty out of 3797 identifiable studies were eligible for the meta-analysis. A total of 19 definitions of IKF were described and categorized into three types: the threshold of eGFR, an absolute or percent decrease in eGFR, and certain eGFR threshold combined with decrement in eGFR. The eGFR< 60 ml/min/1.73m2 was the most widely used definition or criterion for IKF, by which the pooled incidence rate of IKF was 12.50 (95%CI: 9.00–17.36) per 1000 person years (PYs). The second most-studied outcome was a > 25% decrease in eGFR, followed by eGFR< 90 ml/min/1.73m2, eGFR< 30 ml/min/1.73m2 and a combination of eGFR threshold plus decreased eGFR. The reported incidence rates of IKF differ widely by different definitions of IKF. The highest pooled incidence was observed for those with > 25% decrease in eGFR, while the lowest was observed in those with eGFR < 30 ml/min/1.73m2. Substantial heterogeneity was identified across most estimates. Conclusion Our study provides a comprehensive summary of eGFR-based definitions and incidence rates of IKF in PLWH, not only promoting our understanding of IKF, but also underscoring needs for a concerted action to unify definitions and outcomes of IKF and their applications in AIDS care. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02721-x.
Collapse
|
4
|
Funke B, Spinner CD, Wolf E, Heiken H, Christensen S, Stellbrink HJ, Witte V. High prevalence of comorbidities and use of concomitant medication in treated people living with HIV in Germany - results of the BESIDE study. Int J STD AIDS 2020; 32:152-161. [PMID: 33323070 DOI: 10.1177/0956462420942020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to demographic changes in people living with HIV (PLHIV), physicians are challenged with age-related comorbidities and their management. In the absence of comprehensive data collection, the burden of comorbidities and co-medication in addition to antiretroviral therapy (ART) remains unclear for the German real-world setting. BESIDE was an observational, cross-sectional study evaluating the prevalence of comorbidities and use of co-medication in treated PLHIV. Regional distribution of study centers (n = 20), consecutive patient recruitment, and age-stratified sampling in alignment with national epidemiologic data aimed to ensure a representative sample (n = 453). The overall prevalence of comorbidities was 91.2%; 31.6% of patients had ≥4 comorbidities. The most common diagnoses were vitamin D deficiency (29.1%), depressive episode (27.8%), arterial hypertension (16.3%), and hypercholesterolemia (10.8%). 83.7% of patients were on co-medication; 21.2% taking ≥4 medications. The most common medications or supplements were vitamins (31.6%), anti-inflammatory agents (16.1%), renin-angiotensin system agents (12.1%), acid suppressants (11.7%), lipid modifying agents (10.8%); 1.3% of patients were on co-medication that should not be co-administered with ART, 41.5% on co-medication with potential for drug-drug interactions. The prevalence of comorbidities and use of co-medication among treated PLHIV in Germany is consistently high and increases across age groups, illustrating the complexity of HIV care involving appropriate ART selection.
Collapse
Affiliation(s)
- B Funke
- MSD Sharp & Dohme GmbH, Medical Affairs, Haar, Germany
| | - C D Spinner
- Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Munich, Germany
| | - E Wolf
- MUC Research, Munich, Germany.,MVZ Karlsplatz, HIV Research and Clinical Care Centre, Munich, Germany
| | - H Heiken
- Praxis Georgstrasse, Hanover, Germany
| | - S Christensen
- Center for Interdisciplinary Medicine (CIM) Infectious Diseases, Muenster, Germany
| | | | - V Witte
- MSD Sharp & Dohme GmbH, Medical Affairs, Haar, Germany
| |
Collapse
|
5
|
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
| | | |
Collapse
|
6
|
Kalemeera F, Godman B, Stergachis A, Rennie T. Tenofovir disoproxil fumarate associated nephrotoxicity: a retrospective cohort study at two referral hospitals in Namibia. Pharmacoepidemiol Drug Saf 2020; 30:189-200. [PMID: 33006803 DOI: 10.1002/pds.5125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 07/14/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence and risk factors of tenofovir disoproxil fumarate (TDF)-related renal impairment (RI) in Namibia are unknown where TDF-containing ART regimens are used as the first line for HIV. METHODOLOGY A retrospective cohort study among HIV-infected patients at two intermediate hospitals. A decline in estimated glomerular filtration rate (eGFR) was significant if it was ≥25% and included a change to a lower eGFR stage. New-onset RI was defined as an eGFR <50 mL/min/1.73m2 . RESULTS 10 387 patients were included: 11.4% (n = 1182) experienced the decline in eGFR. Of these, 0.6% (n = 62) migrated to eGFR stages IV and V. The incidence was 4.5 (95% CI: 4.3-4.8) per 100 patient years. RI developed in 400 patients for an incidence rate of 2.4 (95% CI: 2.2-2.6) cases per 100 patient years. Risk factors with effect sizes >2.0, for decline-in-eGFR were baseline eGFR >60 (aHR = 15.6); hyperfiltration (aHR = 5.0); and pregnancy (aHR = 2.4); while for RI, they were hyperfiltration (aHR = 4.1) and pregnancy (aHR = 29). CONCLUSION The incidence of decline-in-eGFR was higher than in other sub-SSA countries, but not RI. A high baseline eGFR had the greatest risk for the decline, and hyperfiltration for the RI.
Collapse
Affiliation(s)
- Francis Kalemeera
- Department of Pharmacology and Therapeutics, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Brian Godman
- Clinical Pharmacology, Pharmacoeconomics, Karolinska Institute (Sweden); Sefako Makgatho Health Sciences University (South Africa); Strathchlyde Institue of Pharmacy and Biomedical Sciences (Scotland)
| | - Andy Stergachis
- School of Pharmacy and School of Public Health, University of Washington, Seattle, Washington, USA
| | - Timothy Rennie
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Wijting IE, Rokx C, Zillikens MC, Smits SA, de Vries-Sluijs TE, Schurink CA, Bax HI, van der Ende ME, van Gorp EC, Nouwen JL, Verbon A, Bierman WF, Rijnders BJ. Changes in renal, bone, lipid, and inflammation markers in HIV-1 patients after combination antiretroviral therapy simplification to dolutegravir monotherapy. Int J STD AIDS 2019; 30:1042-1048. [PMID: 31431155 DOI: 10.1177/0956462419848962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Combination antiretroviral therapy (cART) can cause metabolic toxicities. How cART simplification to dual or monotherapies affects metabolic markers is unknown. We analyzed the metabolic effects of cART simplification to dolutegravir (DTG) monotherapy in the randomized clinical DOMONO (DOlutegravir MONOtherapy for HIV) trial including HIV-positive participants. Renal function, Framingham risk score (FRS), inflammation, and bone mineral density (BMD) with trabecular bone score (TBS) were measured during 48 weeks after simplification. The changes at 48 weeks by on-treatment analyses overall and for prior tenofovir disoproxil fumarate (TDF) exposure were analyzed separately, using Bonferroni corrected alpha (p = 0.00096). Ninety-five patients initiated DTG monotherapy, including 80 discontinuing TDF. At week 48, the switch to DTG monotherapy resulted in an expected −7.8 ml/min estimated glomerular filtration decline. In patients on prior TDF, proteinuria improved (p < 0.00096), but proximal tubular dysfunction proportions did not change. Fasting lipids, FRS, and the inflammation markers C-reactive protein and CD4:CD8 T-cell ratio remained stable. Lumbar spine BMD improved (+1.7%, p < 0.00096), while hip BMD and TBS remained comparable. Simplification of TDF-containing cART to DTG monotherapy ameliorated lumbar spine BMD and proteinuria with neutral effect on lipids and inflammation markers. Although DTG monotherapy should not be used in routine care and its role in strictly selected patients with primary HIV infection needs to be further elucidated, these observations remain relevant regarding DTG-based dual therapy without TDF. www.clinicaltrials.gov registration number: NCT02401828.
Collapse
Affiliation(s)
- Ingeborg Ea Wijting
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Casper Rokx
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Maria C Zillikens
- Department of Internal Medicine and Endocrinology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Sandra Aa Smits
- Department of Internal Medicine and Endocrinology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Theodora Ems de Vries-Sluijs
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Carolina Am Schurink
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Hannelore I Bax
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Marchina E van der Ende
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Eric Cm van Gorp
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Jan L Nouwen
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Annelies Verbon
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Wouter Fw Bierman
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart Ja Rijnders
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| |
Collapse
|
9
|
Maggi P, Santoro CR, Nofri M, Ricci E, De Gennaro N, Bellacosa C, Schiaroli E, Orofino G, Menzaghi B, Di Biagio A, Squillace N, Francisci D, Vichi F, Molteni C, Bonfanti P, Gaeta GB, De Socio GV. Clusterization of co-morbidities and multi-morbidities among persons living with HIV: a cross-sectional study. BMC Infect Dis 2019; 19:555. [PMID: 31238916 PMCID: PMC6593514 DOI: 10.1186/s12879-019-4184-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/12/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Among people living with HIV (PLWH), the prevalence of non-HIV related co-morbidities is increasing. Aim of the present study is to describe co-morbidity and multi-morbidity, their clustering mode and the potential disease-disease interactions in a cohort of Italian HIV patients. METHODS Cross-sectional analysis conducted by the Coordinamento Italiano per lo Studio di Allergia e Infezioni da HIV (CISAI) on adult subjects attending HIV-outpatient facilities. Non-HIV co-morbidities included: cardiovascular disease, diabetes mellitus, hypertension, oncologic diseases, osteoporosis, probable case of chronic obstructive pulmonary disease (COPD), hepatitis C virus (HCV) infection, psychiatric illness, kidney disease. Multi-morbidity was defined as the presence of two or more co-morbidities. RESULTS One thousand and eighty-seven patients were enrolled in the study (mean age 47.9 ± 10.8). One hundred-ninety patients (17.5%) had no co-morbidity, whereas 285 (26.2%) had one condition and 612 (56.3%) were multi-morbid. The most recurrent associations were: 1) dyslipidemia + hypertension (237, 21.8%); 2) dyslipidemia + COPD (188, 17.3%); 3) COPD + HCV-Ab+ (141, 12.9%). Multi-morbidity was associated with older age, higher body mass index, current and former smoking, CDC stage C and longer ART duration. CONCLUSIONS More than 50% of PLHW were multi-morbid and about 30% had three or more concurrent comorbidities. The identification of common patterns of comorbidities address the combined risks of multiple drug and disease-disease interactions.
Collapse
Affiliation(s)
- Paolo Maggi
- Infectious Diseases Clinic University of Campania "Luigi Vanvitelli", Neaples, Italy
| | | | - Marco Nofri
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Elena Ricci
- Department of Women, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | | | - Elisabetta Schiaroli
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio, VA, Italy
| | | | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy.,Infectious Diseases Clinic, "Santa Maria" Hospital, University of Perugia, Terni, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Usl centro, Florence, Italy
| | - Chiara Molteni
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | | | - Giuseppe Vittorio De Socio
- Infectious Diseases Clinic, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| |
Collapse
|
10
|
Joshi K, Boettiger D, Kerr S, Nishijima T, Van Nguyen K, Ly PS, Lee MP, Kumarasamy N, Wong W, Kantipong P, Cuong DD, Kamarulzaman A, Choi JY, Zhang F, Chaiwarith R, Ng OT, Kiertiburanakul S, Sim BLH, Merati TP, Yunihastuti E, Ditangco R, Ross J, Pujari S. Changes in renal function with long-term exposure to antiretroviral therapy in HIV-infected adults in Asia. Pharmacoepidemiol Drug Saf 2018; 27:1209-1216. [PMID: 30246898 PMCID: PMC6218305 DOI: 10.1002/pds.4657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/06/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Renal disease is common among people living with human immunodeficiency virus (HIV). However, there is limited information on the incidence and risk factors associated with renal dysfunction among this population in Asia. METHODS We used data from the TREAT Asia HIV Observational Database. Patients were included if they started antiretroviral therapy during or after 2003, had a serum creatinine measurement at antiretroviral therapy initiation (baseline), and had at least 2 follow-up creatinine measurements taken ≥3 months apart. Patients with a baseline estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 were excluded. Chronic kidney disease was defined as 2 consecutive eGFR values ≤60 mL/min/1.73 m2 taken ≥3 months apart. Generalized estimating equations were used to identify factors associated with eGFR change. Competing risk regression adjusted for study site, age and sex, and cumulative incidence plots were used to evaluate factors associated with chronic kidney disease (CKD). RESULTS Of 2547 patients eligible for this analysis, tenofovir was being used by 703 (27.6%) at baseline. Tenofovir use, high baseline eGFR, advanced HIV disease stage, and low nadir CD4 were associated with a decrease in eGFR during follow-up. Chronic kidney disease occurred at a rate of 3.4 per 1000 patient/years. Factors associated with CKD were tenofovir use, old age, low baseline eGFR, low nadir CD4, and protease inhibitor use. CONCLUSIONS There is an urgent need to enhance renal monitoring and management capacity among at-risk groups in Asia and improve access to less nephrotoxic antiretrovirals.
Collapse
Affiliation(s)
- Kedar Joshi
- Institute of Infectious Diseases, Pune, India
| | | | - Stephen Kerr
- HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
| | - Wingwai Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | | |
Collapse
|
11
|
Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
| | | |
Collapse
|
12
|
Cristelli MP, Trullàs JC, Cofán F, Rico N, Manzardo C, Ambrosioni J, Bedini JL, Moreno A, Diekmann F, Miro JM. Prevalence and risk factors of mild chronic renal failure in HIV-infected patients: influence of female gender and antiretroviral therapy. Braz J Infect Dis 2018; 22:193-201. [PMID: 29782827 PMCID: PMC9425679 DOI: 10.1016/j.bjid.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/25/2018] [Accepted: 05/01/2018] [Indexed: 12/21/2022] Open
Abstract
Background In people living with HIV, much is known about chronic kidney disease, defined as a glomerular filtration rate under 60 mL/min. However, there is scarce data about prevalence and risk factors for milder impairment (60–89 mL/min). Objective The present study aims to assess the influence of sex, antiretroviral therapy, and classical risk factors on the occurrence of mild decreased renal function in a large Spanish cohort of HIV-infected patients. Methods Cross-sectional, single center study, including all adult HIV-1-infected patients under antiretroviral treatment with at least two serum creatinine measures during 2014, describing the occurrence of and the risk factors for mildly decreased renal function (eGFR by CKD-EPI creatinine equation of 60–89 mL/min). Results Among the 4337 patients included, the prevalence rate of mildly reduced renal function was 25%. Independent risk factors for this outcome were age older than 50 years (OR 3.03, 95% CI 2.58–3.55), female sex (OR 1.23, 95% CI 1.02–1.48), baseline hypertension (OR 1.57, 95% CI 1.25–1.97) or dyslipidemia (OR 1.48, 95% CI 1.17–1.87), virologic suppression (OR 1.88, 95% CI 1.39–2.53), and exposure to tenofovir disoproxil-fumarate (OR 1.67, 95% CI 1.33–2.08) or ritonavir-boosted protease-inhibitors (OR 1.19, 95% CI 1.03–1.39). Conclusions Females and patients over 50 seem to be more vulnerable to renal impairment. Potentially modifiable risk factors and exposure to tenofovir disoproxil-fumarate or ritonavir-boosted protease-inhibitors are present even in earlier stages of chronic kidney dysfunction. It remains to be determined whether early interventions including antiretroviral therapy changes (tenofovir alafenamide, cobicistat) or improving comorbidities management will improve the course of chronic kidney disease.
Collapse
Affiliation(s)
- Marina Pontello Cristelli
- Universidade Federal de São Paulo, Hospital do Rim, Divisão de Transplante Renal, São Paulo, SP, Brazil.
| | - Joan Carles Trullàs
- University of Girona, Medical Sciences Department, Hospital de Olot, Internal Medicine Service, Girona, Spain
| | - Federico Cofán
- University of Barcelona, Hospital Clinic - Institut D'Investigacions Biomèdiques August Pi i Sunyer, Nephrology and Renal Transplantation Service, Barcelona, Spain
| | - Naira Rico
- Hospital Clínic, Biomedical Diagnosis Center, Core Laboratory, Barcelona, Spain
| | - Christian Manzardo
- University of Barcelona, Hospital Clinic - Institut D'Investigacions Biomèdiques August Pi i Sunyer, Infectious Diseases Service, Barcelona, Spain
| | - Juan Ambrosioni
- University of Barcelona, Hospital Clinic - Institut D'Investigacions Biomèdiques August Pi i Sunyer, Infectious Diseases Service, Barcelona, Spain
| | - Josep Lluis Bedini
- Hospital Clínic, Biomedical Diagnosis Center, Core Laboratory, Barcelona, Spain
| | - Asunción Moreno
- University of Barcelona, Hospital Clinic - Institut D'Investigacions Biomèdiques August Pi i Sunyer, Infectious Diseases Service, Barcelona, Spain
| | - Fritz Diekmann
- University of Barcelona, Hospital Clinic - Institut D'Investigacions Biomèdiques August Pi i Sunyer, Nephrology and Renal Transplantation Service, Barcelona, Spain
| | - Jose Maria Miro
- University of Barcelona, Hospital Clinic - Institut D'Investigacions Biomèdiques August Pi i Sunyer, Infectious Diseases Service, Barcelona, Spain
| | | |
Collapse
|
13
|
McLaughlin MM, Guerrero AJ, Merker A. Renal effects of non-tenofovir antiretroviral therapy in patients living with HIV. Drugs Context 2018; 7:212519. [PMID: 29623097 PMCID: PMC5866095 DOI: 10.7573/dic.212519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/19/2022] Open
Abstract
A review of literature published regarding non-tenofovir antiretroviral agents causing renal adverse effects was conducted. The literature involving renal adverse effects and antiretroviral therapy is most robust with protease inhibitors, specifically atazanavir and indinavir, and includes reports of crystalluria, leukocyturia, nephritis, nephrolithiasis, nephropathy and urolithiasis. Several case reports describe potential nephropathy (including Fanconi syndrome) secondary to administration of abacavir, didanosine, lamivudine and stavudine. Case reports documented renal events such as acute renal failure, nephritis, proteinuria and renal stones with efavirenz administration. Regarding rilpivirine, a small increase of serum creatinine levels (SCr) was found in clinical trials; however, the clinical significance and impact on actual renal function is unknown. The integrase strand transfer inhibitors and enfuvirtide have a relatively safe renal profile, although studies have shown dolutegravir and raltegravir cause mild elevations in SCr without an impact on actual renal function. This is similar to the reaction observed with cobicistat, the pharmacokinetic enhancer frequently given with elvitegravir.
Collapse
Affiliation(s)
- Milena M McLaughlin
- Chicago College of Pharmacy, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA.,Northwestern Memorial Hospital, 251 E Huron St, Chicago, IL 60611, USA
| | - Aimee J Guerrero
- Chicago College of Pharmacy, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA
| | - Andrew Merker
- Chicago College of Pharmacy, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA.,Mount Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60608, USA
| |
Collapse
|
14
|
Abstract
Aim of database The Danish Nephrology Registry’s (DNR) primary function is to support the Danish public health authorities’ quality control program for patients with end-stage renal disease in order to improve patient care. DNR also supplies epidemiological data to several international organizations and supports epidemiological and clinical research. Study population The study population included patients treated with dialysis or transplantation in Denmark from January 1, 1990 to January 1, 2016, with retrospective data since 1964. Main variables DNR registers patient data (eg, age, sex, renal diagnosis, and comorbidity), predialysis specialist treatment, details of eight dialysis modalities (three hemodialysis and five peritoneal dialysis), all transplantation courses, dialysis access at first dialysis, treatment complications, and biochemical variables. The database is complete (<1% missing data). Patients are followed until death or emigration. Descriptive data DNR now contains 18,120 patients, and an average of 678 is added annually. Data for each transplantation course include donor details, tissue type, time to onset of graft function, and cause of graft loss. Registered complications include peritonitis in peritoneal dialysis patients, causes of peritoneal dialysis technique failure, and transplant rejections. Fifteen biochemical variables are registered, mainly describing anemia control, mineral and bone disease, nutritional and uremia status. Date and cause of death are also included. Six quality indicators are published annually, and have been associated with improvements in patient results, eg, a reduction in dialysis patient mortality, improved graft survival, and earlier referral to specialist care. Approximately, ten articles, mainly epidemiological, are published each year. Conclusion DNR contains a complete description of end-stage renal disease patients in Denmark, their treatment, and prognosis. The stated aims are fulfilled.
Collapse
Affiliation(s)
- James Heaf
- Department of Medicine, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| |
Collapse
|
15
|
Abstract
OBJECTIVE To describe the incidence of rapid kidney function decline (RKFD), and stage 3 chronic kidney disease (CKD) in HIV-1-infected adults initiated on tenofovir-containing antiretroviral therapy. METHODS A retrospective cohort study at the infectious diseases clinic of Tygerberg Academic Hospital in Cape Town, South Africa. Patients with more than 3 ml/min per year decline in estimated glomerular filtration were classified as having RKFD, and stage 3 CKD was defined as a value less than 60 ml/min per 1.73 m. We used logistic and Cox proportional hazards regression models to determine factors associated with RKFD and stage 3 CKD. RESULTS Of 650 patients, 361 (55%) experienced RKFD and 15 (2%) developed stage 3 CKD during a median interquartile range follow-up time of 54 (46.6-98) weeks. For every 10-year increase in age and 10 ml/min lower baseline estimated glomerular filtration, the odds of RKFD increased by 70% [adjusted odds ratio = 1.70, 95% confidence interval (CI) 1.36-2.13] and 57% (adjusted odds ratio = 1.57, 95% CI 1.38-1.80), respectively. Each 10-year older age was associated with a 1.90-fold increased risk of developing stage 3 CKD (adjusted hazard ratio = 1.90, 95% CI: 1.10-3.29). Women had about four-fold greater risk of stage 3 CKD compared with men (adjusted hazard ratio = 3.96, 95% CI: 1.06-14.74). CONCLUSION About half of our study population developed RKFD but only 2% progressed to stage 3 CKD. Approaches that provide balanced allocation of limited resources toward screening and monitoring for kidney dysfunction and HIV disease management are critically needed in this setting.
Collapse
|
16
|
Gianotti N, Galli L, Poli A, Salpietro S, Nozza S, Carbone A, Merli M, Ripa M, Lazzarin A, Castagna A. Estimated Glomerular Filtration Rate Trajectories in HIV-Infected Subjects Treated With Different Ritonavir-Boosted Protease Inhibitors and Tenofovir Disoproxil Fumarate or Abacavir. Medicine (Baltimore) 2016; 95:e3780. [PMID: 27258510 PMCID: PMC4900718 DOI: 10.1097/md.0000000000003780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate in human immunodeficiency virus (HIV)-infected patients estimated glomerular filtration rate (eGFR) trajectories during treatment with different protease inhibitors (PIs) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus tenofovir (TDF) or abacavir (ABC) and lamivudine or emtricitabine (xTC).Retrospective study of patients followed at a single clinical center; all patients who started TDF or ABC for the first time with a NNRTI or lopinavir/r (LPV/r) or atazanavir/r (ATV/r) or darunavir/r (DRV/r), for whom at least 1 eGFR value before the start and during the studied treatment was known, were included in this analysis. eGFR was calculated by means of the CKD-EPI formula. Univariate and multivariate mixed linear model (MLM) was applied to estimate eGFR slope with the considered antiretroviral treatment.In the 1658 patients treated with TDF/xTC (aged 43 [37-48] years, with an eGFR of 105 [96; 113] mL/min/1.73 m, 80% males, 92% Caucasians, 10% coinfected with HCV, 4% with diabetes, 11% with hypertension, 38% naive for antiretroviral therapy (ART), 37% with HIV-RNA <50 copies/mL) the median follow-up was 2.5 (1.2-4.6) years. Their adjusted eGFR slopes (95% CI) were -1.26 (-1.58; -0.95), -0.43 (-1.20; +0.33), -0.86 (-1.28; -0.44), and -0.20 (-0.42; +0.02) mL/min/1.73 m per year in patients treated with ATV/r, DRV/r, LPV/r, and NNRTI, respectively. Patients receiving ATV/r or LPV/r had a greater adjusted decline in eGFR compared with those receiving NNRTIs (difference -1.06 [-1.44; -0.69] mL/min/1.73 m per year, P <0.001; and -0.66 [-1.13; -0.20] mL/min/1.73 m per year, P = 0.005, respectively); adjusted eGFR slopes were similar in patients receiving DRV/r and in those receiving NNRTIs. Patients receiving ATV/r had a greater adjusted eGFR decline than those treated with DRV/r (difference -0.83 [-1.65; -0.02] mL/min/1.73 m per year; P = 0.04), but not than those receiving LPV/r; no significant difference was observed in adjusted eGFR slopes between patients receiving DRV/r and those receiving LPV/r. In the 286 patients treated with ABC and lamivudine, eGFR slopes were similar, independent of the PI.In patients receiving TDF/xTC, eGFR trajectories were small for all regimens and declined less in patients receiving DRV/r or NNRTIs than in those treated with ATV/r or LPV/r.
Collapse
Affiliation(s)
- Nicola Gianotti
- From the Infectious Diseases (NG, LG, AP, SS, SN, AC, MM, MR, AL, AC), San Raffaele Scientific Institute; and Università Vita-Salute San Raffaele (AP, AC, MM, MR, AL, AC), Milano, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVES To describe the spectrum of renal tubular disease (RTD) in HIV-positive patients and its association with exposure to antiretroviral therapy (ART). DESIGN Review of 265 consecutive renal biopsies from HIV-positive patients attending eight clinics in the United Kingdom between 2000 and 2012. METHODS We described the clinical characteristics of patients with RTD and compared current/recent exposure (at the time of, or up to 3 months prior to the date of biopsy) to potentially nephrotoxic ART [tenofovir (TDF), atazanavir (ATV), indinavir (IDV) and lopinavir/ritonavir (LPV/r)]. We also analysed the incidence of RTD in the UK CHIC cohort. Kruskall-Wallis, analysis of variance and Fisher's exact tests were used to evaluate between-group differences. RESULTS Of the 60 RTD cases, 54 (90%) were included in the analyses. RTD comprised of three distinct patterns: acute tubular injury (ATI, n = 22), tubulo-interstitial nephritis (TIN, n = 20) and interstitial fibrosis and tubular atrophy (IFTA, n = 12). Compared with TIN and IFTA, ATI cases were less likely to be of black ethnicity (10 vs. 42-55%; P = 0.006), more likely to be on ART (100 vs. 55-68%; P = 0.001), with HIV-RNA below 200 copies/ml (100 vs. 54-58%; P < 0.001), and more likely to have current/recent exposure to TDF (P < 0.001). We did not find evidence for an association between exposure to TDF, ATV/r or LPV/r and either TIN or IFTA. CONCLUSION RTD was present in approximately 20% of renal biopsies and comprised three distinct injury patterns with considerable clinical overlap. ATI was associated with TDF exposure, although the overall incidence of biopsy-defined ATI was low.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Zhao Y, Zhang M, Shi CX, Zhang Y, Cai W, Zhao Q, Li Y, Li H, Liu X, Chen L, Ma Y, Zhang F, Liu Z, Wu Z. Renal Function in Chinese HIV-Positive Individuals following Initiation of Antiretroviral Therapy. PLoS One 2015; 10:e0135462. [PMID: 26317657 PMCID: PMC4552675 DOI: 10.1371/journal.pone.0135462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 07/22/2015] [Indexed: 02/02/2023] Open
Abstract
Aim To identify the prevalence and predictors of abnormal renal function among HIV-positive Chinese patients prior to antiretroviral therapy (ART) initiation and to evaluate subsequent changes in renal function after ART exposure. Methods We conducted a nationwide cohort study of subjects who enrolled in the national Chinese ART program from January 1, 2012 to December 31, 2012. We estimated the glomerular filtration rate (eGFR) of subjects prior to and after initiating ART. Risk factors for abnormal renal function, as defined by eGFR <60 ml/min/1.73m2, at baseline and follow-up were assessed by logistic regression and Cox proportional hazards regression models, respectively. Results Among 41,862 subjects, at ART baseline, 3.3% had a baseline eGFR <60 ml/min/1.73m2 and 24.2% had eGFR = 60–90 ml/min/1.73m2. Adjusted baseline risk factors for baseline eGFR <60 ml/min/1.73m2 were older age (Adjusted odds ratio [AOR] = 5.19, 95% confidence interval [CI]: 4.52–5.67), female (AOR = 1.68, 95% CI: 1.47–1.93), hemoglobin <120g/L (AOR = 1.68, 95% CI: 1.47–1.93), blood glucose >6.1 mmol/L (AOR = 1.46, 95% CI: 1.25–1.72), and hepatitis C co-infection (AOR = 1.36, 95% CI: 1.06–1.73). Among subjects with baseline eGFR >90 ml/min/1.73m2, the incidence of the eGFR falling to <60 ml/min/1.73m2 was 0.92/100 person-years after a median of 15.0 months of ART. Being on a tenofovir with lopinavir/ritonavir regimen (Adjusted hazard ratio [AHR] = 3.02, 95% CI: 1.96–4.66) and having an unsuppressed viral load (AHR = 2.70, 95% CI: 1.80–4.03) were independent predictors for eGFR <60 ml/min/1.73m2 after ART initiation as well as older age, female, and hemoglobin <120 g/L. Conclusion A high proportion of HIV-positive subjects in China presented with abnormal renal function prior to ART initiation. But the incidence of the eGFR decrease after ART was low. Patient renal function should be regularly monitored by eGFR before initiating and during ART.
Collapse
Affiliation(s)
- Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mingjie Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Cynthia X. Shi
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yao Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | | | - Yong Li
- Longtan Hospital, Guangxi, China
| | | | - Xia Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limeng Chen
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ye Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fujie Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (FZ); (ZL)
| | - Zhongfu Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (FZ); (ZL)
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Hara M, Suganuma A, Yanagisawa N, Imamura A, Hishima T, Ando M. Atazanavir nephrotoxicity. Clin Kidney J 2015; 8:137-42. [PMID: 25815168 PMCID: PMC4370314 DOI: 10.1093/ckj/sfv015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 02/26/2015] [Indexed: 02/06/2023] Open
Abstract
Atazanavir is commonly used as one of the key drugs in combination antiretroviral therapy for human immunodeficiency virus (HIV). However, atazanavir has the potential to yield its crystalline precipitation in urine and renal interstitial tissues, leading to crystalluria, urolithiasis, acute kidney injury (AKI) or chronic kidney disease (CKD). In epidemiological studies, atazanavir/ritonavir alone or in combination with tenofovir has been associated with increased risk of progression to CKD. However, renal biopsies were not provided in these studies. Case reports showing an association between atazanavir use and tubulointerstitial nephritis among HIV-infected individuals provide clues as to the potential causes of atazanavir nephrotoxicity. We now review atazanavir-related kidney disease including urolithiasis, renal dysfunction and interstitial nephritis and illustrate the review with a further case of atazanavir-associated kidney injury with sequential renal biopsies. There are two forms of atazanavir-associated tubulointerstitial nephritis: acute tubulointerstitial nephritis that may develop AKI rapidly (in weeks) after initiation of atazanavir, and chronic tubulointerstitial nephritis that may develop progressive CKD slowly (in years) with granuloma and intrarenal precipitation of atazanavir crystals as well as crystalluria. Caution should be exercised when prescribing atazanavir to patients at high risk of CKD, and therapy should be reevaluated if renal function deteriorates, especially associated with crystalluria and hematuria.
Collapse
Affiliation(s)
- Masaki Hara
- Renal Division, Department of Medicine , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Akihiko Suganuma
- Division of Infectious Diseases, Department of Medicine , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Naoki Yanagisawa
- Division of Infectious Diseases, Department of Medicine , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Akifumi Imamura
- Division of Infectious Diseases, Department of Medicine , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Tsunekazu Hishima
- Department of Pathology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Minoru Ando
- Renal Division, Department of Medicine , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| |
Collapse
|
22
|
Kumar N, Perazella MA. Differentiating HIV-associated nephropathy from antiretroviral drug-induced nephropathy: a clinical challenge. Curr HIV/AIDS Rep 2015; 11:202-11. [PMID: 24924830 DOI: 10.1007/s11904-014-0209-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With the introduction of potent combination antiretroviral therapy (cART) into clinical practice, HIV-infected patients have garnered much benefit. However, kidney disease continues to be a potential complication in this group. Whereas HIV-associated nephropathy (HIVAN) was the major renal complication prior to cART, co-morbid diseases and adverse renal effects of various drugs, in particular cART, now complicate the landscape. Clinicians now must differentiate HIVAN from cART nephrotoxicity. While sometimes this is easy and relatively straightforward, often the clinician faces a difficult challenge distinguishing these two etiologies of kidney disease. This review will discuss HIVAN and cART-related kidney disease and review the clinical and laboratory data that may be useful in differentiating these processes. Often, however, kidney biopsy may be required to differentiate HIVAN from cART nephrotoxicity as well as other kidney lesions associated with concurrent co-morbidities, both infectious and non-infectious.
Collapse
Affiliation(s)
- Neelja Kumar
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, BB 114, 330 Cedar Street, New Haven, CT, 06520-8029, USA
| | | |
Collapse
|
23
|
Bagnis CI, Stellbrink HJ. Protease Inhibitors and Renal Function in Patients with HIV Infection: a Systematic Review. Infect Dis Ther 2015; 4:15-50. [PMID: 25567681 PMCID: PMC4363218 DOI: 10.1007/s40121-014-0056-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Despite antiretroviral (ARV) therapy reducing renal disease in human immunodeficiency virus overall, there is concern that certain ARVs, particularly tenofovir disoproxil fumarate (TDF) with or without a boosted protease inhibitor (PI), may reduce renal function over time. It is not known whether effects seen with PI-based regimens are independent, result from interactions with TDF coadministration, or are artefactual owing to inhibition of renal tubular creatinine transport by ritonavir or cobicistat pharmacoenhancement. The aim of this review was to conduct a systematic review of studies, weighted toward high-quality evidence, examining changes in renal function over time with PI-based regimens. METHODS PubMed, Embase, and Medline databases and conference abstracts were searched using pre-defined terms for English language articles, published up to and including August 12, 2013, describing changes in renal function over time with PI-based regimens. All available randomized controlled trials (RCTs) were selected; however, to reduce bias, only observational studies recruiting from more than one center and analyzing data from more than 1,000 patients were included. Evidence was qualitatively evaluated according to levels established by the Oxford Centre for Evidence-Based Medicine (OCEBM). RESULTS A total of 2,322 articles were retrieved by the initial search. Of these, 37 were selected for full review, comprising 24 RCTs (OCEBM Level 1 evidence: 4 reports of fully double-blinded or blinded with respect to the PI component). The remaining 20 RCTs and 13 observational studies qualified as OCEBM Level 2 evidence. Level 1 evidence showed initial but non-progressive increases in serum creatinine and corresponding decreases in estimated glomerular filtration rate (eGFR), suggesting an effect on renal tubular transport of creatinine. Level 2 evidence suggested that atazanavir and lopinavir especially in combination with TDF were associated with non-progressive reductions in eGFR over time, with a decreased risk for the development of chronic kidney disease (CKD) on cessation and without the development of advanced CKD or end-stage renal disease (ESRD); whether these reductions were independent or associated with interactions with coadministered TDF could not be established with certainty. Data on darunavir were insufficient to draw any conclusions. The principal limitation of the reviewed studies was the lack of standardization of creatinine measurements in virtually all studies and the lack of corroborative data on changes in proteinuria or other indices of renal function. DISCUSSION In this review, there was little evidence for progressive changes in eGFR, or the development of advanced CKD, or ESRD with lopinavir or atazanavir. Further long-term studies, employing a wide range of validated renal function assessments, are required to fully evaluate potential association of PIs with CKD.
Collapse
Affiliation(s)
- Corinne Isnard Bagnis
- Nephrology Department, Pitie Salpetriere Hospital and UPMC-CNAM-EHESS Research Chair for "Patient Education", Pierre et Marie Curie University, Paris, France,
| | | |
Collapse
|
24
|
Husain NEO, Ahmed MH. Managing dyslipidemia in HIV/AIDS patients: challenges and solutions. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 7:1-10. [PMID: 25565897 PMCID: PMC4274137 DOI: 10.2147/hiv.s46028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Human immunodeficiency virus (HIV) is a chronic disease associated with dyslipidemia and insulin resistance. In addition, the administration of combination antiretroviral therapy is associated with an increase in the incidence of metabolic risk factors (insulin resistance, lipoatrophy, dyslipidemia, and abnormalities of fat distribution in HIV patients). HIV dyslipidemia is a common problem, and associated with an increase in incidence of cardiovascular disease. Further challenges in the management of HIV dyslipidemia are the presence of diabetes and metabolic syndrome, nonalcoholic fatty liver disease, hypothyroidism, chronic kidney disease, the risk of diabetes associated with statin administration, age and ethnicity, and early menopause in females. Dyslipidemia in patients with HIV is different from the normal population, due to the fact that HIV increases insulin resistance and HIV treatment not only may induce dyslipidemia but also may interact with lipid-lowering medication. The use of all statins (apart from simvastatin and lovastatin) is safe and effective in HIV dyslipidemia, and the addition of ezetimibe, fenofibrate, fish oil, and niacin can be used in statin-unresponsive HIV dyslipidemia. The management of dyslipidemia and cardiovascular disease risks associated with HIV is complex, and a certain number of patients may require management in specialist clinics run by specialist physicians in lipid disorders. Future research is needed to address best strategies in the management of hyperlipidemia with HIV infection.
Collapse
Affiliation(s)
- Nazik Elmalaika Os Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine, Milton Keynes Hospital, NHS Foundation Trust, Milton Keynes, UK
| |
Collapse
|
25
|
Cheserem E, Mabonga E, Post FA. HIV and the kidney: a UK perspective. Br J Hosp Med (Lond) 2014; 75:197-201. [PMID: 24727957 DOI: 10.12968/hmed.2014.75.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E Cheserem
- Locum Consultant in HIV Medicine in the Department of HIV/Sexual Health, University Hospital Lewisham, London
| | - E Mabonga
- Specialist Registrar in HIV and Genitourinary Medicine in the Department of HIV/Sexual Health, Kings College Hospital, London
| | - F A Post
- Reader in HIV Medicine in the Department of Renal Medicine, Kings College London School of Medicine at Guys, Kings College and St Thomas Hospitals, Weston Education Centre, London SE5 9RJ and Honorary Consultant Physician, Kings College Hospital, Lon
| |
Collapse
|
26
|
Antiretrovirals and the kidney in current clinical practice: renal pharmacokinetics, alterations of renal function and renal toxicity. AIDS 2014; 28:621-32. [PMID: 24983540 DOI: 10.1097/qad.0000000000000103] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Assessment of renal function in HIV-positive patients is of increasing importance in the context of ageing and associated comorbidities. Exposure to nephrotoxic medications is widespread, and several commonly used antiretroviral drugs have nephrotoxic potential. Moreover, specific antiretrovirals inhibit renal tubular transporters resulting in the potential for drug-drug interactions as well as increases in serum creatinine concentrations, which affect estimates of glomerular filtration rate in the absence of changes in actual glomerular filtration rate. This review explores the effects of antiretroviral therapy on the kidney and offers an understanding of mechanisms that lead to apparent and real changes in renal function.
Collapse
|
27
|
Rasch MG, Helleberg M, Feldt-Rasmussen B, Kronborg G, Larsen CS, Pedersen C, Pedersen G, Gerstoft J, Obel N. Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population. Nephrol Dial Transplant 2013; 29:1232-8. [PMID: 23975841 DOI: 10.1093/ndt/gft289] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND HIV patients have increased risk of impaired renal function. We aimed to estimate the incidence of any renal replacement therapy (aRRT) and start of chronic renal replacement therapy (cRRT) among HIV patients compared with population controls. METHODS In a nationwide, population-based cohort study we analysed incidence rates (IR), incidence rate ratios (IRR) and risk factors for aRRT and cRRT among HIV patients compared with an age- and gender-matched population control cohort using Poisson regression. RESULTS We identified 5300 HIV patients and 53 000 population controls. The IRs per 10 000 person-years of aRRT and cRRT among HIV patients were 15.9 (95% CI: 12.5-20.1) and 4.4 (95% CI: 2.8-6.9), respectively. The IRR was 4.7 (95% CI: 3.5-6.2) for aRRT and 3.6 (95% CI: 2.2-6.0) for cRRT compared with population controls. Risk of aRRT was increased during the first year after HIV diagnosis [IRR 3.5 (95% CI: 1.5-8.1)], after a diagnosis of AIDS [IRR 2.3 (95% CI: 1.3-3.9)], in intravenous drug users [IRR 6.0 (95% CI: 2.9-12.2)] and in patients with hypertension [IRR 7.0 (95% CI: 3.7-13.2)]. Factors associated with increased risk of cRRT were hypertension [IRR 20 (95% CI: 6.8-61)] and baseline eGFR < 60 mL/min pr. 1.73 m(2) [IRR 7.8 (95% CI: 1.2-50)]. Exposure to tenofovir and/or atazanavir was not associated with risk of aRRT or cRRT. CONCLUSIONS The risk of aRRT is increased more than 4-fold and the risk of cRRT is increased more than 3-fold in HIV patients in Denmark compared with the background population. We found no association between exposure to tenofovir, atazanavir or the combination of the two and risk of aRRT or cRRT.
Collapse
Affiliation(s)
- Magnus G Rasch
- Faculty of Health Sciences, University of Copenhagen, 1455 København K, Denmark Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Marie Helleberg
- Faculty of Health Sciences, University of Copenhagen, 1455 København K, Denmark Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Carsten S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Gerstoft
- Faculty of Health Sciences, University of Copenhagen, 1455 København K, Denmark
| | - Niels Obel
- Faculty of Health Sciences, University of Copenhagen, 1455 København K, Denmark
| |
Collapse
|
28
|
Prevalence of renal disease within an urban HIV-infected cohort in northern Italy. Clin Exp Nephrol 2013; 18:104-12. [PMID: 23712539 DOI: 10.1007/s10157-013-0817-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 05/02/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Renal disease is an increasingly recognized noninfectious comorbidity associated with human immunodeficiency virus (HIV) infection. METHODS Our retrospective, cross-sectional study evaluated prevalence of nephropathy among HIV-infected patients followed up in our outpatient clinic during the year 2011. Renal dysfunction and chronic kidney disease (CKD) were defined as estimated glomerular filtration rate (eGFR) <90 ml/min per 1.73 m(2) and as renal damage or eGFR <60 ml/min per 1.73 m(2) over a 3-month or greater period, respectively. RESULTS We enrolled 894 HIV-infected patients with a mean age of 44.2 years and a mean current CD4 lymphocyte count of 508 cells/mm(3). The prevalence of renal dysfunction and CKD was 27.4 and 21.3 %, respectively. Older age, male gender, hypertension, diabetes, proteinuria, hypertriglyceridemia, lower nadir CD4 cell count, current use of tenofovir or tenofovir plus a ritonavir-boosted protease inhibitor were independently associated with renal dysfunction. CONCLUSION Renal dysfunction is a frequent comorbidity among HIV-infected persons and requires a careful clinical and laboratory monitoring of renal function.
Collapse
|