Hepatitis C seropositivity and kidney function decline among women with HIV: data from the Women's Interagency HIV Study.
BACKGROUND
How coinfection with hepatitis C virus (HCV) impacts on the trajectory of kidney function in human immunodeficiency virus (HIV)-infected patients is unclear. This study examined the effect of HCV infection on kidney function over time in women infected with HIV.


METHODS
Retrospective observational cohort.


METHODS
Study sample included participants from the Women's Interagency HIV Study who were HIV infected and had undergone HCV antibody testing and serum creatinine measurement at baseline.


METHODS
HCV seropositivity.


METHODS
Estimated glomerular filtration rate (eGFR) calculated from semi-annual serum creatinine measurements using the 4-variable Modification of Diet in Renal Diseases (MDRD) Study equation. Linear mixed models were used to evaluate the independent effect of HCV seropositivity on eGFR over time, adjusting for demographic factors, comorbid conditions, illicit drug use, measures of HIV disease status, use of medications, and interactions with baseline low eGFR (<60 mL/min/1.73 m(2)).


RESULTS
Of 2,684 HIV-infected women, 952 (35%) were found to be HCV seropositive. In 180 women with chronic kidney disease (CKD) at baseline (eGFR < 60 mL/min/1.73 m(2)), HCV seropositivity was independently associated with a fully adjusted net decrease in eGFR of approximately 5% per year (95% confidence interval, 3.2 to 7.2) relative to women who were seronegative. In contrast, HCV infection was not independently associated with a decrease in eGFR in women without low eGFR at baseline (P < 0.001 for interaction).


CONCLUSIONS
The MDRD Study equation has not been validated as a measure of GFR in persons with HIV or HCV infection. Proteinuria was not included in the study analysis. Because the study is observational, effects of residual confounding cannot be excluded.


CONCLUSIONS
In HIV-infected women with CKD, coinfection with HCV is associated with a modest, but statistically significant, decrease in eGFR over time. More careful monitoring of kidney function may be warranted for HIV-infected patients with CKD who are also coinfected with HCV.
Tsui
Judith
J
Boston University School of Medicine, Boston, MA 02118, USA. judith.tsui@bmc.edu
Vittinghoff
Eric
E
Anastos
Kathryn
K
Augenbraun
Michael
M
Young
Mary
M
Nowicki
Marek
M
Cohen
Mardge H
MH
Peters
Marion G
MG
Golub
Elizabeth T
ET
Szczech
Lynda
L
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000503:physiopathology*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology*; D006526:Hepatitis C / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016014:Linear Models; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies
D003404:Creatinine