Comparison of risk factors and outcomes in HIV immune complex kidney disease and HIV-associated nephropathy

HIV-associated nephropathy (HIVAN) is well described, but the clinical features of a group of renal pathologies characterized by Ig or immune complex depositions referred to as HIV-associated immune complex kidney disease (HIVICK) have not been well established. The objective of this study is to ass...

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Veröffentlicht in:Clinical journal of the American Society of Nephrology Jg. 8; H. 9; S. 1524
Hauptverfasser: Foy, Matthew C, Estrella, Michelle M, Lucas, Gregory M, Tahir, Faryal, Fine, Derek M, Moore, Richard D, Atta, Mohamed G
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.09.2013
Schlagworte:
Adult
African Americans
AIDS-Associated Nephropathy - complications
AIDS-Associated Nephropathy - drug therapy
AIDS-Associated Nephropathy - physiopathology
AIDS-Associated Nephropathy - virology
Anti-Retroviral Agents - therapeutic use
Case-Control Studies
CD4 Lymphocyte Count
Diabetes Complications
Disease Progression
Female
Glomerular Filtration Rate
HIV - genetics
Humans
Hypertension - complications
Immune Complex Diseases - complications
Immune Complex Diseases - drug therapy
Immune Complex Diseases - physiopathology
Immune Complex Diseases - virology
Kidney Diseases - complications
Kidney Diseases - physiopathology
Kidney Diseases - virology
Kidney Failure, Chronic - virology
Male
Middle Aged
Risk Factors
RNA, Viral - blood
United States
Viral Load
United States
ISSN:1555-905X, 1555-905X
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Zusammenfassung:HIV-associated nephropathy (HIVAN) is well described, but the clinical features of a group of renal pathologies characterized by Ig or immune complex depositions referred to as HIV-associated immune complex kidney disease (HIVICK) have not been well established. The objective of this study is to assess risk factors for HIVICK compared with contemporaneous control participants. A nested case-control study of 751 HIV-infected patients followed from January 1996 to June 2010 was conducted. Groups were compared using the chi-squared test or rank-sum analysis. Conditional logistic regression was used to estimate odds ratios (ORs) for HIVICK. Incidences of overall ESRD and with/without combined antiretroviral therapy (cART) exposure were calculated. HIVICK patients were predominantly African American (92%). Compared with matched controls, patients with HIVICK were more likely to have HIV RNA >400 copies/ml (OR, 2.5; 95% confidence interval [95% CI], 1.2 to 5.2), diabetes (OR, 2.8; 95% CI, 1.1 to 6.8), and hypertension (OR, 2.3; 95% CI, 1.2 to 4.5). Compared with HIVAN, patients with HIVICK had more antiretroviral therapy exposure, lower HIV viral loads, and higher CD4 and estimated GFR. ESRD was less common in the HIVICK versus the HIVAN group (30% versus 82%; P<0.001), and the use of cART was not associated with ESRD in HIVICK patients (25% versus 26; P=0.39). HIVICK was predominantly observed in African-American patients and associated with advanced HIV disease. ESRD incidence is lower in HIVICK patients compared with those with HIVAN. Unlike HIVAN, cART use was not associated with the incidence of ESRD in HIVICK.
Bibliographie:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ISSN:1555-905X
1555-905X
DOI:10.2215/CJN.10991012