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Microalbuminuria Is Associated With All-Cause and AIDS Mortality in Women With HIV Infection

Wyatt, Christina M MD*; Hoover, Donald R PhD; Shi, Qiuhu PhD; Seaberg, Eric PhD§; Wei, Catherine MA; Tien, Phyllis C MD¶#; Karim, Roksana MD**; Lazar, Jason MD††; Young, Mary A MD‡‡; Cohen, Mardge H MD§§; Klotman, Paul E MD*; Anastos, Kathryn MD‖‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1st, 2010 - Volume 55 - Issue 1 - p 73-77
doi: 10.1097/QAI.0b013e3181cc1070
Brief Report: Clinical Science

Objectives: Prevalence of microalbuminuria is increased in patients with HIV. Microalbuminuria is associated with increased mortality in other populations, including diabetics, for whom microalbuminuria testing is standard of care. We investigated whether microalbuminuria is associated with mortality in HIV-infected women not receiving antiretroviral therapy.

Methods: Urinalysis for proteinuria and semiquantitative testing for microalbuminuria were performed in specimens from 2 consecutive visits in 1547 HIV-infected women enrolled in the Women's Interagency HIV Study in 1994-1995. Time to death was modeled using proportional hazards analysis.

Results: Compared with women without albuminuria, the hazard ratio (HR) for all-cause mortality was increased in women with 1 (HR: 3.4; 95% CI: 2.2 to 5.2) or 2 specimens positive for either proteinuria or microalbuminuria (HR: 3.9; 95% CI: 2.1 to 7.0). The highest risk was observed in women with both specimens positive for proteinuria (HR: 5.8; 95% CI: 3.4 to 9.8). The association between albuminuria and all-cause mortality risk remained significant after adjustment for demographics, HIV disease severity, and related comorbidities. Similar results were obtained for AIDS death.

Conclusions: We identified a graded relationship between albuminuria and the risk of all-cause and AIDS mortality.

From the *Department of Medicine, Mount Sinai School of Medicine, New York, NY; †Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick NJ; ‡School of Health Sciences and Practice, New York Medical College, Valhalla, NY; §Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD; ∥Albert Einstein College of Medicine, Bronx, NY; ¶Department of Medicine, University of California, San Francisco, CA; #Department of Veterans Affairs Medical Center, Medical Service, San Francisco, CA; **Departments of Pediatrics and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; ††Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY; ‡‡Department of Medicine, Georgetown University Medical Center, Washington, DC; §§Department of Medicine, Cook County Hospital, Chicago IL; and ∥∥Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.

Received for publication October 9, 2009; accepted November 13, 2009.

Support for this work was provided by the National Institutes of Health.

The WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and the National Institute of Child Health and Human Development (UO1-HD-32632). The study is cofunded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding is also provided by the National Center for Research Resources (UCSF-CTSI Grant Number UL1 RR024131).

C.M.W. is supported by the National Institute of Diabetes and Digestive and Kidney Disease (K23-DK-077568). P.C.T. is supported by NIAID (K23-AI-66943).

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

All authors contributed to the design of this analysis, interpretation of data, and critical revision of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions in this article on the journal's Web site (www.jaids.com).

Correspondence to: Christina Wyatt, MD, Mount Sinai School of Medicine, Box 1243, One Gustave L. Levy Place, New York, NY 10029, (e-mail: christina.wyatt@mssm.edu).

© 2010 Lippincott Williams & Wilkins, Inc.