title: Hepatitis C and the risk of kidney disease and mortality in veterans with HIV.
abstract: 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.
authors.affiliation: Department of Medicine/Section of Nephrology, Jesse Brown VA Medical Center/University of Illinois Medical Center, Chicago, IL 60612, USA. fischerm@uic.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wyatt
authors.forename: Kirsha
authors.initials: K
authors.lastname: Gordon
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents