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Long-term kidney function, proteinuria, and associated risks among HIV-infected and uninfected men

Palella, Frank, J., Jra; Li, Xiuhongb; Gupta, Samir, K.c; Estrella, Michelle, M.d; Phair, John, P.a; Margolick, Joseph, B.b; Detels, Rogere; Kingsley, Lawrencef; Jacobson, Lisa, P.b

doi: 10.1097/QAD.0000000000001807
CLINICAL SCIENCE
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Background: Factors affecting kidney function and proteinuria among HIV-positive (HIV+) and HIV-negative (HIV–) persons need better characterization.

Methods: We evaluated estimated glomerular filtration rate (eGFR, ml/min per 1.73 m2) changes, proteinuria prevalence (a urine protein-to-creatinine ratio of ≥0.2 at two consecutive visits) and associated factors among HIV+ and HIV− men.

Results: There were 917 HIV+ men receiving HAART, 159 HIV+ men not receiving HAART, and 1305 HIV− men seen from October 2003 to September 2014. Median annual eGFR change was −0.5, −0.8% for HIV+ and −0.3% for HIV− men (P < 0.001). Factors significantly (P < 0.05) associated with more than 3% annual eGFR decline were HAART receipt (but no specific antiretroviral drug), age more than 50, hypertension, diabetes, current smoking. Proteinuria existed in 14.9% of visit-pairs among HAART recipients, 5.8% among non-HAART recipients, and 1.9% among HIV− men, and was associated with subsequent annual more than 3% eGFR decline (odds ratio 1.80, P < 0.001). Proteinuria-associated factors also included HAART use (vs. HIV−), age at least 50 (vs. <40), diabetes, hypertension, current smoking, hepatitis C virus-infection (all P < 0.05) and, among HIV+ men, lower CD4+ cell count, didanosine, saquinavir, or nelfinavir use (all P < 0.05). After adjusting for proteinuria, among HAART users, having a detectable HIV RNA, cumulative use of tenofovir disoproxil fumarate, emtricitabine, ritonavir, atazanavir, any protease inhibitor, or fluconazole were associated with more than 3% annual eGFR decline.

Conclusion: Longitudinal kidney function decline was associated with HAART use but no individual antiretroviral drug, and traditional kidney disease risks. Proteinuria was nearly seven times more common in HAART-treated men than HIV− men, reflected recent eGFR decline and predicted subsequent eGFR decline.

aDivision of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

bJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

cIndiana University School of Medicine, Indianapolis, Indiana

dDivision of Nephrology, University of California San Francisco School of Medicine, San Francisco

eUniversity of California Los Angeles School of Public Health, Los Angeles, California

fUniversity of Pittsburgh Graduate School of Public Health, Pitts burgh, Pennsylvania, USA.

Correspondence to Frank J. Palella Jr, MD, Potocsnak Family Professor of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. E-mail: f-palella@northwestern.edu

Received 24 September, 2017

Revised 8 February, 2018

Accepted 21 February, 2018

Copyright © 2018 Wolters Kluwer Health, Inc.