Antiretroviral therapy in the treatment of HIV-associated nephropathy.
BACKGROUND
The effect of antiretroviral therapy (ART) on the clinical course of patients with human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is not well-established. This study was undertaken to further elucidate the potential benefit of ART in HIV-infected patients with documented HIVAN.


METHODS
A cohort of 263 consecutive HIV-infected patients referred to the Johns Hopkins renal clinic from 1995 to 2004 was examined. Patients were included if they had biopsy-proven HIVAN and did not require dialysis within 1 month of their kidney biopsy. The cumulative probability of renal survival was calculated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox regression method.


RESULTS
Fifty-three patients among 152 biopsied patients had HIVAN. Among 36 patients who met the inclusion criteria, 26 were treated with ART (group I) and 10 patients were not (group II). Except for age, baseline demographics and clinical characteristics were similar in the two groups. Renal survival was significantly better in the group receiving ART by both univariate (P = 0.025) and multivariate analysis (overall adjusted hazard ratio = 0.30; 95% confidence interval 0.09-0.98; P < 0.05) for ART compared with no treatment.


CONCLUSIONS
Patients with biopsy-proven HIVAN treated with ART had better renal survival compared with patients who did not receive ART. HIVAN should be considered as an indication to initiate ART.
Atta
Mohamed G
MG
Department of Medicine, Division of Nephrology, Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21205, USA. matta1@jhmi.edu
Gallant
Joel E
JE
Rahman
M Hafizur
MH
Nagajothi
Nagapradeep
N
Racusen
Lorraine C
LC
Scheel
Paul J
PJ
Fine
Derek M
DM
D016263:AIDS-Associated Nephropathy / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012737:Sex Factors; D016019:Survival Analysis
D019380:Anti-HIV Agents