title: Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy.
abstract: BACKGROUND
  We previously reported an increased risk of all-cause and AIDS mortality among HIV-infected women with albuminuria (proteinuria or microalbuminuria) enrolled in the Women's Interagency HIV Study (WIHS) prior to the introduction of HAART.
  
  
  METHODS
  The current analysis includes 1,073 WIHS participants who subsequently initiated HAART. Urinalysis for proteinuria and semi-quantitative testing for microalbuminuria from two consecutive study visits prior to HAART initiation were categorized as follows: confirmed proteinuria (both specimens positive for protein), confirmed microalbuminuria (both specimens positive with at least one microalbuminuria), unconfirmed albuminuria (one specimen positive for proteinuria or microalbuminuria), or negative (both specimens negative). Time from HAART initiation to death was modelled using proportional hazards analysis.
  
  
  RESULTS
  Compared with the reference group of women with two negative specimens, the hazard ratio (HR) for all-cause mortality was significantly increased for women with confirmed microalbuminuria (HR 1.9, 95% CI 1.2-2.9). Confirmed microalbuminuria was also independently associated with AIDS death (HR 2.3, 95% CI 1.3-4.3), whereas women with confirmed proteinuria were at increased risk for non-AIDS death (HR 2.4, 95% CI 1.2-4.6).
  
  
  CONCLUSIONS
  In women initiating HAART, pre-existing microalbuminuria independently predicted increased AIDS mortality, whereas pre-existing proteinuria predicted increased risk of non-AIDS death. Urine testing may identify HIV-infected individuals at increased risk for mortality even after the initiation of HAART. Future studies should consider whether these widely available tests can identify individuals who would benefit from more aggressive management of HIV infection and comorbid conditions associated with mortality in this population.
authors.affiliation: Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA. christina.wyatt@mssm.edu
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wyatt
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.forename: Roksana
authors.initials: R
authors.lastname: Karim
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.forename: Johanna L
authors.initials: JL
authors.lastname: Goderre
authors.forename: Eric C
authors.initials: EC
authors.lastname: Seaberg
authors.forename: Jason
authors.initials: J
authors.lastname: Lazar
authors.forename: Mary A
authors.initials: MA
authors.lastname: Young
authors.forename: Paul E
authors.initials: PE
authors.lastname: Klotman
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D000419:Albuminuria / Q000150:complications*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000150:complications; D012307:Risk Factors; D016019:Survival Analysis