title: Incidence and predictors of acute kidney injury in an urban cohort of subjects with HIV and hepatitis C virus coinfection.
abstract: Coinfection with hepatitis C (HCV) significantly increases the risk of acute and chronic renal disease in HIV-infected individuals. However, the burden of acute kidney injury (AKI) directly attributable to HIV among HCV-infected individuals and associated risk factors are not well understood. Within a prospective cohort, AKI episodes were identified by a rise in creatinine of 0.5 mg/dL. Incidence of first AKI events was calculated for HIV/HCV coinfected versus HCV monoinfected subjects, and multivariable analyses using Cox proportional hazards were performed to identify predictors of AKI. Throughout the study period, 35% HIV/HCV coinfected and 17% HCV monoinfected subjects developed AKI, with incidence of 8.74/100 person-years and 3.53/100 person-years, respectively (hazard ratio (HR) 2.48; [95% confidence interval (CI) 1.50, 3.74]). In multivariable analysis, HIV coinfection (HR 2.19 [1.33, 3.62]), decompensated cirrhosis (HR 6.64 [3.81, 11.6]), and cocaine use (HR 2.06 [1.15, 3.71]) were independently associated with AKI. HCV genotype, HCV viral load, hazardous drinking, and heroin use were not associated with AKI. Study limitations included potential misclassification bias of HCV-infected individuals as serial HIV antibody testing was not routinely performed after study entry, and inability to adjust for tenofovir use in multivariable analysis. In conclusion, among subjects with HCV infection, decompensated cirrhosis, HIV coinfection, and cocaine use are associated with increased risk of AKI. These findings highlight the importance of preventing and treating cirrhosis, controlling HIV coinfection, and reducing cocaine use in HIV/HCV coinfected persons.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. shikhagarg75@yahoo.com
authors.forename: Shikha
authors.initials: S
authors.lastname: Garg
authors.forename: Melanie
authors.initials: M
authors.lastname: Hoenig
authors.forename: Erika M
authors.initials: EM
authors.lastname: Edwards
authors.forename: Caleb
authors.initials: C
authors.lastname: Bliss
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Sheila
authors.initials: S
authors.lastname: Tumilty
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Koziel
authors.forename: Paul R
authors.initials: PR
authors.lastname: Skolnik
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
authors.forename: Deborah
authors.initials: D
authors.lastname: Cotton
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D019970:Cocaine-Related Disorders / Q000150:complications; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D014505:Urban Population; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents