Immunodeficiency and renal impairment are risk factors for HIV-associated acute renal failure.
OBJECTIVE
To identify risk factors for acute renal failure (ARF) in HIV-infected patients.


METHODS
Observational cohort study of HIV-infected patients attending a South London HIV centre between January 1999 and December 2008.


METHODS
ARF was defined as a transient, more than 40% reduction in renal function as assessed by estimated glomerular filtration rate. Multivariate Poisson regression analysis was used to identify baseline and time-updated factors associated with ARF.


RESULTS
The incidence of ARF was 2.8 (95% confidence interval 2.41-3.24) episodes per 100 person-years. We observed a stepwise increase in ARF incidence with time accrued at lower CD4 cell count and at lower estimated glomerular filtration rate, with adjusted incidence rate ratios of 1 (reference), 1.56 (0.97-2.48), 2.08 (1.11-3.91), 6.38 (3.18-12.78) and 10.29 (5.11-20.98) for CD4 cell counts of more than 350, 201-350, 101-200, 51-100 and of 50/microl or less, and 1 (reference), 1.46 (0.86-2.51), 4.19 (2.37-7.42) and 27.00 (16.13-44.95) for estimated glomerular filtration rate more than 90, 75-89, 60-74 and less than 60 ml/min, respectively. Ethnicity, hepatitis B or C coinfection, exposure to combination antiretroviral therapy with or without indinavir, tenofovir or atazanavir and HIV viraemia were not associated with ARF.


CONCLUSIONS
Current levels of immunodeficiency and renal function were independent predictors of HIV-associated ARF.
Ibrahim
Fowzia
F
King's College London, UK.
Naftalin
Claire
C
Cheserem
Emily
E
Roe
Jennifer
J
Campbell
Lucy J
LJ
Bansi
Loveleen
L
Hendry
Bruce M
BM
Sabin
Caroline
C
Post
Frank A
FA
D058186:Acute Kidney Injury / Q000276:immunology* / Q000821:virology; D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000328:Adult; D000069446:Atazanavir Sulfate; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage*; D008131:London; D008297:Male; D009842:Oligopeptides / Q000008:administration & dosage*; D063065:Organophosphonates / Q000008:administration & dosage*; D011725:Pyridines / Q000008:administration & dosage*; D012307:Risk Factors; D000068698:Tenofovir
D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D063065:Organophosphonates; D011725:Pyridines; D000069446:Atazanavir Sulfate; D019469:Indinavir; D000068698:Tenofovir; D000225:Adenine