title: The impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women.
abstract: BACKGROUND
  In the early highly active antiretroviral therapy (HAART) era, kidney dysfunction was strongly associated with death among HIV-infected individuals. We re-examined this association in the later HAART period to determine whether chronic kidney disease remains a predictor of death after HAART initiation.
  
  
  METHODS
  To evaluate the effect of kidney function at the time of HAART initiation on time to all-cause mortality, we evaluated 1415 HIV-infected women initiating HAART in the Women's Interagency HIV Study. Multivariable proportional hazards models with survival times calculated from HAART initiation to death were constructed; participants were censored at the time of the last available visit or December 31, 2006.
  
  
  RESULTS
  Chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m) at HAART initiation was associated with higher mortality risk adjusting for age, race, hepatitis C serostatus, AIDS history, and CD4 cell count (hazard ratio 2.23, 95% confidence interval: 1.45-3.43). Adjustment for hypertension and diabetes history attenuated this association (hazard ratio = 1.89, confidence interval: 0.94-3.80). Lower kidney function at HAART initiation was weakly associated with increased mortality risk in women with prior AIDS (hazard ratio = 1.09, confidence interval: 1.00-1.19, per 20% decrease in estimated glomerular filtration rate).
  
  
  CONCLUSIONS
  Kidney function at HAART initiation remains an independent predictor of death in HIV-infected individuals, especially in those with a history of AIDS. Our study emphasizes the necessity of monitoring kidney function in this population. Additional studies are needed to determine mechanisms underlying the increased mortality risk associated with chronic kidney disease in HIV-infected persons.
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. mestrel1@jhmi.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
authors.forename: Alison
authors.initials: A
authors.lastname: Abraham
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Lynda A
authors.initials: LA
authors.lastname: Szczech
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Jack A
authors.initials: JA
authors.lastname: Dehovitz
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Merenstein
authors.forename: C Leigh
authors.initials: CL
authors.lastname: Pearce
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016001:Confidence Intervals; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D007677:Kidney Function Tests / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents