Factors associated with chronic renal failure in HIV-infected ambulatory patients.
OBJECTIVE
Renal disease is an increasingly common manifestation among HIV-positive persons, particularly during late stages of HIV disease. We performed a cohort-based, nested case-control study to examine the role of several factors in developing HIV-related chronic renal disease, including HIV viral load and CD4+ cell count.


METHODS
Incident cases of chronic renal disease were identified from a cohort of 6361 prospectively followed HIV-1 positive persons. Controls were selected using incidence density sampling and matched 4:1 on age, race/ethnicity, and gender.


METHODS
Odds ratios (OR) and 95% confidence intervals (CI) were obtained using conditional logistic regression.


RESULTS
One hundred and eight cases of chronic renal disease were identified; 80 (74.1%) were eligible for the current analysis. Nadir CD4+ cell count < 200 x 10(6) cells/l (OR = 4.3; 95% CI, 2.1-8.7), highly active antiretroviral therapy (HAART) use for 56 days or more (OR = 0.5; 95% CI, 0.3-1.0), and hypertension [treated with angiotensin-converting enzyme (ACE) inhibitors: OR = 4.6; 95% CI, 1.8-11.6; treated with non-ACE inhibitors: OR = 2.5; 95% CI, 1.0-6.2; not treated: OR = 4.2; 95% CI, 0.8-21.6] were associated with disease. HAART use for 56 days or more modified the associations for nadir CD4+ cell count and hypertension.


CONCLUSIONS
Our findings suggest that advanced HIV-disease, as indicated by low CD4+ cell count, is associated with subsequently developing chronic renal disease and treatment with HAART may reduce the risk of developing chronic renal disease.
Krawczyk
Christopher S
CS
School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. csk323@hotmail.com
Holmberg
Scott D
SD
Moorman
Anne C
AC
Gardner
Lytt I
LI
McGwin
Gerald
G
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D007676:Kidney Failure, Chronic / Q000821:virology*; D008297:Male; D011446:Prospective Studies; D019562:Viral Load
D019380:Anti-HIV Agents