The morbidity and mortality associated with kidney disease in an HIV-infected cohort in Puerto Rico.
BACKGROUND
Nephropathy in HIV-infected patients has been associated with progression to AIDS and death. The virus, several comorbid conditions and certain medications may contribute to the development and progression of kidney disease.


METHODS
This study analyzed data collected from HIV-infected persons enrolled in a HIV registry in Puerto Rico during January 1998 through September 2006. Demographic factors, clinical manifestations, laboratory findings at enrollment, and antiretroviral therapy (ART) prescriptions were compared between patients with and without kidney disease. Death status and cause of death by December 2006 were also evaluated and compared.


RESULTS
The study included 1,283 subjects, 69.0% male, 39.7% injecting drug users, 19.5% hepatitis C infected, 6.5% with diabetes mellitus (DM-2), 11.6% had hypertension (HTN) and 9.0% had kidney disease. Patients with kidney disease had significantly higher (P < .05) HIV viral load mean (273,499 vs. 202,858 copies/mL), CD4 T-cell count < 200 (57.0% vs. 44.4%), underweight (22.9% vs. 10.9%), DM-2 (13.9% vs. 5.8%), HTN (27.8% vs 10.0%) and mortality (15.9 vs 5.7 deaths per 100 years of follow-up) than those without it. Cox proportional hazard analysis showed that patients with kidney disease had a higher mortality risk (2.1) after controlling for age, sex, HIV risk factor, ART prescription in the last year and HIV disease duration.


CONCLUSIONS
This study demonstrated a substantial disparity in mortality for Puerto Rican HIV-infected patients with nephropathy. Kidney disease preventive strategies that include aggressive control of HIV-infection and chronic medical conditions, such as hypertension and diabetes, are recommend as an approach to reduce this health disparity.
Mayor
Angel M
AM
Retrovirus Research Center, Internal Medicine Department, School of Medicine, Universidad Central del Caribe, Puerto Rico. amayorb@hotmail.com
Dworkin
Mark
M
Quesada
Luis
L
Ríos-Olivares
Eddy
E
Hunter-Mellado
Robert F
RF
D016263:AIDS-Associated Nephropathy / Q000208:ethnology* / Q000401:mortality* / Q000517:prevention & control; D000328:Adult; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D007677:Kidney Function Tests / Q000592:standards; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011647:Puerto Rico