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Association of HIV Suppression With Kidney Disease Progression Among HIV-Positive African Americans With Biopsy-Proven Classic FSGS

McMahon, Blaithin A., MD, PhD*,†; Hanouneh, Mohamad, MD*; Chedid, Alice, MD*; Fine, Derek M., MD*; Chen, Teresa K., MD, MHS*; Foy, Matthew, MD; Lucas, Gregory M., MD, PhD§; Estrella, Michelle M., MD, MHS; Atta, Mohamed G., MD, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15, 2018 - Volume 79 - Issue 5 - p 639–643
doi: 10.1097/QAI.0000000000001860
Clinical Science

Background: In the era of combined antiretroviral therapy, classic focal segmental glomerulosclerosis (FSGS) is the most common histopathological finding in African American HIV-positive patients with kidney disease. We sought to determine whether HIV suppression is associated with lower risk of progression to end-stage renal disease (ESRD) among HIV-positive African Americans with biopsy-confirmed classic FSGS.

Methods: HIV-positive African Americans who underwent kidney biopsies at a single tertiary hospital between January 1996 and June 2011 were confirmed as having classic FSGS by the presence of segmental glomerulosclerosis without features of HIV-associated nephropathy. Multivariable Cox proportional hazards models were used to examine the independent association of viral suppression (HIV-RNA < 400 copies per milliliter at biopsy) with time to progression to ESRD.

Results: Of the 55 HIV-positive African Americans with classic FSGS, 26 had suppressed viral loads at the time of biopsy. Compared to viremic patients, those who were virally suppressed had a significantly higher mean CD4+ cell count (452 vs. 260 cell/mm3, respectively; P = 0.02) and median estimated glomerular filtration rate (53.5 vs 35.5 mL/min/1.73 m2, respectively; P = 0.002). Adjusting for sex and baseline CD4+ cell count, estimated glomerular filtration rate, and proteinuria, those with HIV-RNA levels <400 copies per milliliter at baseline had a 75% lower risk of progressing to ESRD (hazard ratio = 0.25; 95% CI: 0.07 to 0.88) during a median follow-up time of 2.70 years (interquartile range: 0.80–5.15 years).

Conclusions: HIV suppression is associated with significantly lower risk of progression to ESRD among HIV-infected African Americans with classic FSGS, supporting the potential role of combined antiretroviral therapy for this histopathology in addition to HIV-associated nephropathy among HIV-positive individuals.

*Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD;

Division of Nephrology, Medical University of South Carolina, Charleston, SC;

Department of Internal Medicine in Baton Rouge, Louisiana State University Medical Center, New Orleans, LA;

§Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD; and

Division of Nephrology, University of California, San Francisco, CA.

Correspondence to: Mohamad Hanouneh, MD, Division of Nephrology, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, Room 416, Baltimore, MD 21287 (e-mail:

Supported by the NIDDK Grant K23DK081317.

The authors have no funding or conflicts of interest to disclose.

M.M.E. and M.G.A. are co-senior authors.

Received June 08, 2018

Accepted August 29, 2018

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