Predictors of renal outcome in HIV-associated nephropathy.
BACKGROUND
Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of end-stage renal disease among African American patients. This study was performed to study the epidemiology of HIVAN in a predominantly black African population and the impact of highly active antiretroviral therapy and other factors on the development of end-stage renal disease.


METHODS
We retrospectively identified all patients with HIVAN, defined by biopsy or strict clinical criteria, in 8 clinics in the United Kingdom. Baseline renal function, HIV parameters, renal pathological index of chronic damage, and responses to highly active antiretroviral therapy were analyzed, and factors associated with adverse renal outcome were identified.


RESULTS
From 1998 through 2004, we studied 16,834 patients, 61 of whom had HIVAN. HIVAN prevalence in black patients was 0.93%, and HIVAN incidence in those without renal disease at baseline was 0.61 per 1000 person-years. After a median of 4.2 years, 34 patients (56%) had developed end-stage renal disease. There were no significant differences in renal function and HIV parameters at baseline, time to initiation of highly active antiretroviral therapy, and rates of HIV RNA suppression between the 20 patients who developed end-stage renal disease >3 months after receiving the HIVAN diagnosis and the 23 patients who maintained stable renal function. However, the index of chronic damage score was significantly higher in those who developed end-stage renal disease (P < .001), and an index of chronic damage score >75 was associated with shorter renal survival (P < .001).


CONCLUSIONS
Whereas overall patient survival suggested an important benefit of highly active antiretroviral therapy, no additional renal benefit of early initiation of highly active antiretroviral therapy or viral suppression could be demonstrated in this large cohort of patients with established HIVAN. Severity of chronic kidney damage, as quantified by biopsy, was the strongest predictor of renal outcome.
Post
Frank A
FA
Academic Dept. of HIV/GUM, King's College London School of Medicine at Guy's, King's College, London, United Kingdom. frank.post@kcl.ac.uk
Campbell
Lucy J
LJ
Hamzah
Lisa
L
Collins
Lisa
L
Jones
Rachael
R
Siwani
Rizwan
R
Johnson
Leann
L
Fisher
Martin
M
Holt
Stephen G
SG
Bhagani
Sanjay
S
Frankel
Andrew H
AH
Wilkins
Edmund
E
Ainsworth
Jonathan G
JG
Larbalestier
Nick
N
Macallan
Derek C
DC
Banerjee
Debasish
D
Baily
Guy
G
Thuraisingham
Raj C
RC
Donohoe
Paul
P
Hendry
Bruce M
BM
Hilton
Rachel M
RM
Edwards
Simon G
SG
Hangartner
Robert
R
Howie
Alexander J
AJ
Connolly
John O
JO
Easterbrook
Philippa J
PJ
D016263:AIDS-Associated Nephropathy / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000209:etiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D001741:Black or African American