title: Impact of cystatin C elevation and albuminuria on probability of adverse outcomes in HIV-infected men receiving HAART.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) has contributed to the longevity of human immunodeficiency virus (HIV)-infected patients; however, improved survival has been accompanied by an increase in the prevalence of kidney disease. Kidney disease may be partly responsible for higher morbidity in HIV-infected patients than in HIV-uninfected subjects.
  
  
  METHODS
  A total of 515 well-controlled HIV-infected men on HAART was enrolled in a 3-year prospective cohort study. The incidence of cancer and CVD was investigated over time. The impact of cystatin C elevation and albuminuria at baseline on the incidence of each disease was examined. Albuminuria was estimated by determining the albumin-to-creatinine ratio (ACR). The cumulative incidence of cancer and CVD was analyzed using the Kaplan-Meier method, stratified by the presence and absence of elevated cystatin C and albuminuria biomarkers. Cox proportional hazards analysis was used to calculate the hazards ratio (HR) and 95% incidence interval (CI) of each biomarker, adjusted for known risk factors.
  
  
  RESULTS
  All participants completed the 3-year follow-up study. During the follow-up period, cancers and CVD developed in 13 (2.5%) and 14 (2.7%) participants, respectively. The Kaplan-Meier estimates were significantly increased for cancer incidence in patients with cystatin C elevation and for CVD in those with albuminuria. The HR (95% CI) of cystatin C elevation for occurrence of cancer was 6.09 (1.30 - 24.6) and the HR (95% CI) of ACR ≥ 20 mg/g for CVD was 8.97 (2.20 - 60.8).
  
  
  CONCLUSIONS
  Cystatin C elevation and/or albuminuria at baseline in HIV-infected men undergoing HAART may be associated with poor prognosis.
authors.affiliation: Department IV of Internal Medicine, Tokyo Women’s Medical University, Kawada-cho, Shinjuku-ku, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yanagisawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Ando
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D055316:Cystatin C / Q000097:blood*; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies
chemical_list: D055316:Cystatin C