title: Microalbuminuria in HIV disease.
abstract: OBJECTIVE
  Microalbuminuria is a marker for early kidney disease and cardiovascular risk. The purposes of this study were to determine the prevalence of microalbuminuria in an HIV-infected clinic population, to test the predictive value of a single urine albumin/creatinine ratio (ACR) to identify persistent microalbuminuria and to examine covariates of microalbuminuria.
  
  
  METHODS
  We conducted a prospective cohort study of HIV-infected subjects (n = 182) without proteinuria (urine protein/creatinine ratio ≥0.5 g/g), elevated serum creatinine, diabetes, or chronic inflammatory conditions. Subjects completed three research visits within 9 months. Microalbuminuria was defined as the geometric mean ACR of 25-355 mg/g for females and 17-250 mg/g for males.
  
  
  RESULTS
  The prevalence of microalbuminuria was 14%. The negative predictive value of a single urine ACR determination was 98%, whereas the positive predictive value was only 74%. Microalbuminuria was similar among Black (15%) and non-Black (14%) subjects (p = 0.8). Subjects with microalbuminuria were more likely to have hypertension (p = 0.02) and metabolic syndrome (p = 0.03). While duration of HIV infection and the level of HIV viremia were similar between groups, those with microalbuminuria were more likely to have a CD4 count <200 cells/μl (p = 0.0003). In a multivariate logistic regression analysis, the only significant independent predictors of microalbuminuria were low CD4 count (p = 0.018) and current ritonavir exposure (p = 0.04).
  
  
  CONCLUSIONS
  The prevalence of microalbuminuria in an HIV-infected clinic population was similar to earlier reports, and was associated with hypertension and impaired immune function. A single normal ACR determination effectively excludes microalbuminuria, whereas an elevated ACR requires confirmation.
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Department of Critical Care Medicine, NIH, Bethesda, MD, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Hadigan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Edwards
authors.forename: Alice
authors.initials: A
authors.lastname: Rosenberg
authors.forename: Julia B
authors.initials: JB
authors.lastname: Purdy
authors.forename: Estee
authors.initials: E
authors.lastname: Fleischman
authors.forename: Lilian
authors.initials: L
authors.lastname: Howard
authors.forename: JoAnn M
authors.initials: JM
authors.lastname: Mican
authors.forename: Karmini
authors.initials: K
authors.lastname: Sampath
authors.forename: Akinbowale
authors.initials: A
authors.lastname: Oyalowo
authors.forename: Antoinette
authors.initials: A
authors.lastname: Johnson
authors.forename: Alexandra
authors.initials: A
authors.lastname: Adler
authors.forename: Catherine
authors.initials: C
authors.lastname: Rehm
authors.forename: Margo
authors.initials: M
authors.lastname: Smith
authors.forename: Leon
authors.initials: L
authors.lastname: Lai
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Kopp
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology* / Q000209:etiology / Q000652:urine; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology