title: The impact of hepatitis C virus coinfection on HIV-related kidney disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  In the era of antiretroviral therapy, non-AIDS complications such as kidney disease are important contributors to morbidity and mortality.
  
  
  OBJECTIVE
  To estimate the impact of hepatitis C coinfection on the risk of kidney disease in HIV patients.
  
  
  METHODS
  Two investigators identified English-language citations in MEDLINE and Web of Science from 1989 through 1 July 2007. References of selected articles were reviewed. Observational studies and clinical trials of HIV-related kidney disease and antiretroviral nephrotoxicity were eligible if they included at least 50 subjects and reported hepatitis C status. Data on study characteristics, population, and kidney disease outcomes were abstracted by two independent reviewers.
  
  
  RESULTS
  After screening 2516 articles, 27 studies were eligible and 24 authors confirmed or provided data. Separate meta-analyses were performed for chronic kidney disease outcomes (n = 10), proteinuria (n = 4), acute renal failure (n = 2), and indinavir toxicity (n = 5). The pooled incidence of chronic kidney disease was higher in patients with hepatitis C coinfection [6.2 versus 4.0%; relative risk 1.49, 95% confidence interval (CI) 1.08-2.06]. In meta-regression, prevalence of black race and the proportion of patients with documented hepatitis C status were independently associated with the risk of chronic kidney disease. The relative risk associated with hepatitis C coinfection was significantly increased for proteinuria (1.15; 95% CI 1.02-1.30) and acute renal failure (1.64; 95% CI 1.21-2.23), with no significant statistical heterogeneity. The relative risk of indinavir toxicity was 1.59 (95% CI 0.99-2.54) with hepatitis C coinfection.
  
  
  CONCLUSIONS
  Hepatitis C coinfection is associated with a significant increase in the risk of HIV-related kidney disease.
authors.affiliation: Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. Christina.wyatt@mssm.edu
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wyatt
authors.forename: Carlos
authors.initials: C
authors.lastname: Malvestutto
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.forename: Paul E
authors.initials: PE
authors.lastname: Klotman
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh