title: Antiretroviral-treated HIV-infected women have similar long-term kidney function trajectories as HIV-uninfected women.
abstract: Natural history studies suggest increased risk for kidney function decline with HIV infection, but few studies have made comparisons with HIV-uninfected women. We examined whether HIV infection treated with highly active antiretroviral therapy (HAART) remains associated with faster kidney function decline in the Women's Interagency HIV Study. HIV-infected women initiating HAART with (n=105) or without (n=373) tenofovir (TDF) were matched to HIV-uninfected women on calendar and length of follow-up, age, systolic blood pressure, hepatitis C antibody serostatus, and diabetes history. Linear mixed models were used to evaluate differences in annual estimated glomerular filtration rate (eGFR). Person-visits were 4,741 and 11,512 for the TDF-treated and non-TDF-treated analyses, respectively. Mean baseline eGFRs were higher among women initiated on TDF-containing HAART and lower among those on TDF-sparing HAART compared to their respective HIV-uninfected matches (p<0.05 for both). HIV-infected women had annual rates of eGFR changes similar to HIV-uninfected matches (p-interaction >0.05 for both). Adjusting for baseline eGFR, mean eGFRs at 1 and 3 years of follow-up among women initiated on TDF-containing HAART were lower than their uninfected matches (-4.98 and -4.26 ml/min/1.73 m(2), respectively; p<0.05 for both). Mean eGFR of women initiated on TDF-sparing HAART was lower versus uninfected matches at 5 years (-2.19 ml/min/1.73 m(2), p=0.03). HAART-treated HIV-infected women had lower mean eGFRs at follow-up but experienced rates of annual eGFR decline similar to HIV-uninfected women. Tenofovir use in HIV-infected women with normal kidney function did not accelerate long-term kidney function decline relative to HIV-uninfected women.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. mestrel1@jhmi.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.forename: Yuezhou
authors.initials: Y
authors.lastname: Jing
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.forename: Dan
authors.initials: D
authors.lastname: Merenstein
authors.forename: Celeste Leigh
authors.initials: CL
authors.lastname: Pearce
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.forename: Jack A
authors.initials: JA
authors.lastname: Dehovitz
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology*
chemical_list: D003404:Creatinine