Predictors of Renal Outcome in HIV-Associated Nephropathy

By:

Post, F.A

Contributor(s): Publication details: 2008ISSN:

10584838

Uniform titles:

Clinical Infectious Diseases

Online resources:

Summary: <div style="line-height: 17.999801635742188px;"><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">BACKGROUND:</h4>Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of end-stagerenal disease among African American patients. This study was performed to study the epidemiology of HIVAN in a predominantly black African population and the impact of highly active antiretroviral therapy and other factors on the development of end-stage renal disease.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">METHODS:</h4>We retrospectively identified all patients with HIVAN, defined by biopsy or strict clinical criteria, in 8 clinics in the United Kingdom. Baseline renal function, HIV parameters, renal pathological index of chronic damage, and responses to highly active antiretroviral therapy were analyzed, and factors associated with adverse renal outcome were identified.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">RESULTS:</h4>From 1998 through 2004, we studied 16,834 patients, 61 of whom had HIVAN. HIVAN prevalence in black patients was 0.93%, and HIVAN incidence in those without renal disease at baseline was 0.61 per 1000 person-years. After a median of 4.2 years, 34 patients (56%) had developed end-stage renal disease. There were no significant differences in renal function and HIV parameters at baseline, time to initiation of highly active antiretroviral therapy, and rates of HIV RNA suppression between the 20 patients who developed end-stage renal disease >3 months after receiving the HIVAN diagnosis and the 23 patients who maintained stable renal function. However, the index of chronic damage score was significantly higher in those who developed end-stage renal disease (P < .001), and an index of chronic damage score >75 was associated with shorterrenal survival (P < .001).<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">CONCLUSIONS:</h4>Whereas overall patient survival suggested an important benefit of highly active antiretroviral therapy, no additional renal benefit of early initiation of highly active antiretroviral therapy or viral suppression could be demonstrated in this large cohort of patients with established HIVAN. Severity of chronic kidney damage, as quantified by biopsy, was the strongest predictor of renal outcome.</div>

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Item type	Home library	Collection	Class number	Status	Date due	Barcode
Book	Ferriman information and Library Service (North Middlesex) Shelves	Staff publications for NMDX		Available

NMUH Staff Publications

<div style="line-height: 17.999801635742188px;"><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">BACKGROUND:</h4>Human immunodeficiency virus (HIV)-associated&nbsp;nephropathy&nbsp;(HIVAN) is an important cause of end-stagerenal&nbsp;disease among African American patients. This study was performed to study the epidemiology of HIVAN in a predominantly black African population and the impact of highly active antiretroviral therapy and other factors on the development of end-stage&nbsp;renal&nbsp;disease.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">METHODS:</h4>We retrospectively identified all patients with HIVAN, defined by biopsy or strict clinical criteria, in 8 clinics in the United Kingdom. Baseline&nbsp;renal&nbsp;function,&nbsp;HIV&nbsp;parameters,&nbsp;renal&nbsp;pathological index of chronic damage, and responses to highly active antiretroviral therapy were analyzed, and factors&nbsp;associated&nbsp;with adverse&nbsp;renal&nbsp;outcome&nbsp;were identified.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">RESULTS:</h4>From 1998 through 2004, we studied 16,834 patients, 61 of whom had HIVAN. HIVAN prevalence in black patients was 0.93%, and HIVAN incidence in those without&nbsp;renal&nbsp;disease at baseline was 0.61 per 1000 person-years. After a median of 4.2 years, 34 patients (56%) had developed end-stage&nbsp;renal&nbsp;disease. There were no significant differences in&nbsp;renal&nbsp;function and&nbsp;HIV&nbsp;parameters at baseline, time to initiation of highly active antiretroviral therapy, and rates of&nbsp;HIV&nbsp;RNA suppression between the 20 patients who developed end-stage&nbsp;renal&nbsp;disease &gt;3 months after receiving the HIVAN diagnosis and the 23 patients who maintained stable&nbsp;renal&nbsp;function. However, the index of chronic damage score was significantly higher in those who developed end-stage&nbsp;renal&nbsp;disease (P &lt; .001), and an index of chronic damage score &gt;75 was&nbsp;associated&nbsp;with shorterrenal&nbsp;survival (P &lt; .001).<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;">CONCLUSIONS:</h4>Whereas overall patient survival suggested an important benefit of highly active antiretroviral therapy, no additional&nbsp;renal&nbsp;benefit of early initiation of highly active antiretroviral therapy or viral suppression could be demonstrated in this large cohort of patients with established HIVAN. Severity of chronic kidney damage, as quantified by biopsy, was the strongest predictor of&nbsp;renal&nbsp;outcome.</div>

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