Hepatitis B and C co-infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults.
Chronic kidney disease (CKD) is an important cause of morbidity and mortality in HIV-positive individuals. Hepatitis C (HCV) co-infection has been associated with increased risk of CKD, but prior studies lack information on potential mechanisms. We evaluated the association between HCV or hepatitis B (HBV) co-infection and progressive CKD among 3,441 antiretroviral-treated clinical trial participants. Progressive CKD was defined as the composite of end-stage renal disease, renal death, or significant glomerular filtration rate (eGFR) decline (25% decline to eGFR <60 mL/min/1.73 m(2) or 25% decline with a baseline <60). Generalized Estimating Equations were used to model the odds of progressive CKD. At baseline, 13.8% and 3.3% of participants were co-infected with HCV and HBV, respectively. Median eGFR was 111, and 3.7% developed progressive CKD. After adjustment, the odds of progressive CKD were increased in participants with HCV (OR 1.72, 95% CI 1.07-2.76) or HBV (OR 2.26, 95% CI 1.15-4.44). Participants with undetectable or low HCV-RNA had similar odds of progressive CKD as HCV seronegative participants, while participants with HCV-RNA >800,000 IU/ml had increased odds (OR 3.07; 95% CI 1.60-5.90). Interleukin-6, hyaluronic acid, and the FIB-4 hepatic fibrosis index were higher among participants who developed progressive CKD, but were no longer associated with progressive CKD after adjustment. Future studies should validate the relationship between HCV viremia and CKD.


BACKGROUND
ClinicalTrials.gov NCT00027352; NCT00004978.
Research Department of Infection and Population Health, University College London Medical School, London, United Kingdom.
Amanda
A
Mocroft
Jacqueline
J
Neuhaus
Lars
L
Peters
Lene
L
Ryom
Markus
M
Bickel
Daniel
D
Grint
Janak
J
Koirala
Aleksandra
A
Szymczak
Jens
J
Lundgren
Michael J
MJ
Ross
Christina M
CM
Wyatt
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D060085:Coinfection; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006679:HIV Seropositivity / Q000188:drug therapy / Q000821:virology*; D006509:Hepatitis B / Q000235:genetics / Q000821:virology*; D006526:Hepatitis C / Q000235:genetics / Q000821:virology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D014766:Viremia; D055815:Young Adult
D019380:Anti-HIV Agents