Association between renal disease and outcomes among HIV-infected women receiving or not receiving antiretroviral therapy.
BACKGROUND
The associations of proteinuria and an elevated creatinine level with progression to acquired immunodeficiency syndrome (AIDS) and death in the era of highly antiretroviral therapy (HAART) have not been fully described.


METHODS
This analysis includes 2038 human immunodeficiency virus (HIV)-infected women from the Women's Interagency HIV Study. Time to the development of a new AIDS-defining illness (ADI) and death was modeled using proportional hazards regression before the widespread availability of HAART and after initiation of HAART.


RESULTS
Of the 2038 subjects, the 14.1% of women with proteinuria had lower CD4 lymphocyte counts and higher viral loads (P<.0001 for all) at baseline and before initiation of HAART. Before the widespread availability of HAART, proteinuria was associated with an increased risk for development of ADI (hazard ratio [HR], 1.37; P=.005), and proteinuria and an elevated creatinine level were both associated with an increased risk of death (for proteinuria: HR, 1.35 [P=.04]; for creatinine: HR, 1.72 per decrease in the inverse unit [P=.02]). Among women initiating HAART, an elevated creatinine level remained associated with an increased risk of development of ADI (HR, 1.54 per decrease in the inverse unit; P=.03), and proteinuria and an elevated creatinine level were associated with an increased risk of death (for proteinuria: HR, 2.07 [P=.005]; for creatinine: HR, 1.96 per decrease in the inverse unit [P=.04]).


CONCLUSIONS
Proteinuria and an elevated creatinine level were associated with an increased risk of death and development of ADI. These associations may reflect the direct role of the kidney in modulating HIV disease, or they may act as markers of greater comorbidity.
Szczech
Lynda Anne
LA
Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. szcze001@mc.duke.edu
Hoover
Donald R
DR
Feldman
Joseph G
JG
Cohen
Mardge H
MH
Gange
Stephen J
SJ
Goozé
Lisa
L
Rubin
Nancy R
NR
Young
Mary A
MA
Cai
Xiaotao
X
Shi
Qiuhu
Q
Gao
Wei
W
Anastos
Kathryn
K
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003404:Creatinine / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000209:etiology*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011507:Proteinuria; D013997:Time Factors; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D003404:Creatinine