title: The impact of hepatitis C coinfection on kidney disease related to human immunodeficiency virus (HIV): a biopsy study.
abstract: Approximately 1 in 4 individuals infected with the human immunodeficiency virus (HIV) in the United States is coinfected with the hepatitis C virus. Both conditions increase the risk for the development and progression of kidney disease. The effect, however, of coexisting HIV and hepatitis C infection on the spectrum and progression of kidney disease is not well known. To compare the clinical features, histopathologic kidney diagnoses, and proportion of individuals progressing to end-stage kidney disease (ESKD), we reviewed the clinical records of HIV-infected individuals with and without hepatitis C coinfection who underwent ultrasound-guided percutaneous kidney biopsies between February 7, 1995, and March 30, 2009.Of the 249 HIV-infected individuals included in this study, 58% were coinfected with hepatitis C. Coinfected individuals were older (mean age, 46 ± 7 vs. 44 ± 10 yr, respectively; p < 0.01) and more likely to have used illicit drugs (85% vs. 14%, respectively; p < 0.01) compared to HIV-infected individuals without hepatitis C. HIV-associated nephropathy was the most common histopathologic diagnosis in both groups. Immune-complex glomerulonephritides (ICGNs), including lupus-like nephritis, postinfectious glomerulonephritis, membranous glomerulopathy, membranoproliferative glomerulonephritis, IgA nephropathy, and nonspecific ICGNs, occurred more frequently in individuals coinfected with hepatitis C than in those not coinfected (22% vs. 11%, respectively; p = 0.02). Although the proportion of those who died was similar between the 2 groups, hepatitis C coinfection was independently associated with a greater risk of progression to ESKD (hazard ratio, 1.81; 95% confidence interval, 1.09-2.99; p = 0.02).The current study demonstrates that coinfection with hepatitis C in individuals infected with HIV predisposes these individuals to immune-complex glomerulonephritides and is associated with increased risk of ESKD in the biopsied population.
authors.affiliation: From All India Institute of Medical Sciences (EG), New Delhi, India; Department of Medicine (GNN), St. Luke's-Roosevelt Hospital Center, New York, New York; Division of Nephrology (MME, CJS, MGA, DMF) and Division of Infectious Diseases (GML), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: George
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.forename: C John
authors.initials: CJ
authors.lastname: Sperati
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
authors.forename: Derek M
authors.initials: DM
authors.lastname: Fine
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007105:Immune Complex Diseases / Q000150:complications / Q000175:diagnosis*; D007668:Kidney / Q000648:ultrastructure*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D012189:Retrospective Studies