Clinical epidemiology of HIV-associated end-stage renal failure in the UK.
OBJECTIVE
To describe the clinical epidemiology of HIV-associated end-stage renal failure (HIV/ESRF) from 1998 to 2007 in the United Kingdom.


METHODS
Observational cohort study.


METHODS
Seven leading HIV centres and affiliated renal clinics in the United Kingdom.


METHODS
A total of 21 951 patients in whom renal function was measured.


METHODS
Development of end-stage renal failure (ESRF) as defined by initiation of permanent renal replacement therapy (pRRT).


RESULTS
Sixty-eight (0.31%) patients had HIV/ESRF, 44 (64.7%) of whom were black. The prevalence of ESRF in black patients increased over time from 0.26% in 1998-1999 to 0.92% in 2006-2007 (P for trend = 0.001). Overall 5-year survival from starting pRRT was 70.3%, and significantly better for black patients compared to those of other ethnicities (85.2 vs. 43.4%, P = 0.001). In multivariable analysis, black ethnicity was associated with a higher risk of ESRF [HR 6.93, 95% confidence interval (CI) 3.56, 13.48], whereas a higher current CD4 cell count was associated with reduced risk (HR: 0.83, 95% CI 0.76, 0.95) per 50 cells higher). No association was seen between current viral load or current highly active antiretroviral therapy (HAART) status and ESRF. On the basis of these observations, we estimate that 231 HIV-infected patients required pRRT in the United Kingdom in 2007, and an HIV prevalence of 0.51% among the United Kingdom pRRT recipients in that year.


CONCLUSIONS
The prevalence of HIV/ESRF increased during the HAART era to reach nearly 1% in black patients, in whom favourable survival rates were observed. Earlier HIV diagnosis will be an important strategy to stem the rising trend of HIV/ESRF.
Bansi
Loveleen
L
University College London Medical School, London, UK.
Hughes
Amelia
A
Bhagani
Sanjay
S
Mackie
Nicola E
NE
Leen
Clifford
C
Levy
Jeremy
J
Edwards
Simon
S
Connolly
John
J
Holt
Steve G
SG
Hendry
Bruce M
BM
Sabin
Caroline
C
Post
Frank A
FA
D016263:AIDS-Associated Nephropathy / Q000453:epidemiology* / Q000208:ethnology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology; D019562:Viral Load