Hepatitis C and the risk of kidney disease and mortality in veterans with HIV.
OBJECTIVE
To examine the effect of hepatitis C virus (HCV) on the prevalence of chronic kidney disease (CKD) among veterans with HIV and to evaluate independent associations of HCV and CKD with mortality.


METHODS
We studied a national cohort of HIV-infected patients receiving care through the Veterans Healthcare Administration from 1998 to 2004. CKD was defined as an estimated glomerular filtration rate [eGFR (mL/min/1.73 m2)] < 60. Poisson regression was used to assess relationships between CKD, HCV, and mortality.


RESULTS
Among 23,155 HIV-infected veterans, 12% had CKD. Forty percent of the cohort was coinfected with HCV, and a higher proportion of coinfected subjects had CKD compared with monoinfected subjects (14% vs 11%, P < 0.001). During the median follow-up of 7.6 years, 37% of subjects died and a graduated increase in adjusted mortality rates occurred with lower levels of eGFR (P < 0.001). Adjusted mortality rates were consistently higher in HCV-coinfected subjects across all levels of eGFR (P < 0.001). HCV was independently associated with increased mortality (incidence rate ratio 1.23, 95% confidence interval 1.17-1.29).


CONCLUSIONS
CKD is prevalent in HIV-infected veterans and associated with substantially higher mortality. Compared with their monoinfected counterparts, veterans coinfected with HCV have significantly higher rates of CKD and mortality.
Fischer
Michael J
MJ
Department of Medicine/Section of Nephrology, Jesse Brown VA Medical Center/University of Illinois Medical Center, Chicago, IL 60612, USA. fischerm@uic.edu
Wyatt
Christina M
CM
Gordon
Kirsha
K
Gibert
Cynthia L
CL
Brown
Sheldon T
ST
Rimland
David
D
Rodriguez-Barradas
Maria C
MC
Justice
Amy C
AC
Parikh
Chirag R
CR
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D014481:United States; D014728:Veterans; D055815:Young Adult
D019380:Anti-HIV Agents