Kidney diseases in HIV/HCV-co-infected patients.
BACKGROUND
Hepatitis C virus (HCV) co-infection occurs in 25% of HIV-infected persons. The impact of HIV/HCV coinfection on renal and patient outcomes is unclear.


METHODS
The main objective of the study is the comparison of outcomes (progression to advanced renal failure, initiation of dialysis, and death) in patients with HIV (n = 40), HCV (n = 30) or coinfection (n = 30) during the period between January 1999 and December 2007.


RESULTS
Patients were predominantly white men with a mean creatinine clearance of 50.6 +/- 32.2 ml per min per 1.73 m. Membranoproliferative glomerulonephritis (MPGN) and HIV-associated nephropathy were found in 34 and 9%, respectively. Seventeen patients needed transitory or definitive hemodialysis after 2, 2.5, and 12 months in HIV/HCV (n = 5), HIV (n = 6) and HCV (n = 6) infections, respectively. In multivariate analysis, variables found to independently predict outcome in HIV/HCV coinfected patients were younger age, a longer delay to kidney biopsy, cryoglobulinemia and MPGN. Twenty-one patients died, mostly in the HCV (n = 8) and/or HIV/HCV coinfected (n = 12) groups. The relative risk of death for HIV/HCV co-infected patients was 2.1 times more than for HCV-infected patients and 7.5 times more than for HIV-infected patients. HIV/HCV co-infection [odds ratio (OR), = 4; 95% confidence interval (CI), 1.3-12.9; P = 0.015] and MPGN (OR, 6; 95% CI, 2-18.8; P = 0.0018) were independently associated with death.


CONCLUSIONS
Kidney disease is a relatively frequent complication in HIV or HCV monoinfected individuals. The impact of kidney disease on survival of HIV/HCV coinfected patients seems deleterious but remains largely unknown.
Izzedine
Hassane
H
Departments of Nephrology, Pitie-Salpetriere Hospital, Paris, France. hassan.izzedine@psl.ap-hop-paris.fr
Sene
Damien
D
Cacoub
Patrice
P
Jansen
Helena
H
Camous
Laurent
L
Brocheriou
Isabelle
I
Bourry
Edward
E
Deray
Gilbert
G
D016263:AIDS-Associated Nephropathy / Q000150:complications; D000328:Adult; D000367:Age Factors; D000368:Aged; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000821:virology; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000821:virology