title: Comparison of risk factors and outcomes in HIV immune complex kidney disease and HIV-associated nephropathy.
abstract: OBJECTIVE
  HIV-associated nephropathy (HIVAN) is well described, but the clinical features of a group of renal pathologies characterized by Ig or immune complex depositions referred to as HIV-associated immune complex kidney disease (HIVICK) have not been well established. The objective of this study is to assess risk factors for HIVICK compared with contemporaneous control participants.
  
  
  METHODS
  A nested case-control study of 751 HIV-infected patients followed from January 1996 to June 2010 was conducted. Groups were compared using the chi-squared test or rank-sum analysis. Conditional logistic regression was used to estimate odds ratios (ORs) for HIVICK. Incidences of overall ESRD and with/without combined antiretroviral therapy (cART) exposure were calculated.
  
  
  RESULTS
  HIVICK patients were predominantly African American (92%). Compared with matched controls, patients with HIVICK were more likely to have HIV RNA >400 copies/ml (OR, 2.5; 95% confidence interval [95% CI], 1.2 to 5.2), diabetes (OR, 2.8; 95% CI, 1.1 to 6.8), and hypertension (OR, 2.3; 95% CI, 1.2 to 4.5). Compared with HIVAN, patients with HIVICK had more antiretroviral therapy exposure, lower HIV viral loads, and higher CD4 and estimated GFR. ESRD was less common in the HIVICK versus the HIVAN group (30% versus 82%; P<0.001), and the use of cART was not associated with ESRD in HIVICK patients (25% versus 26; P=0.39).
  
  
  CONCLUSIONS
  HIVICK was predominantly observed in African-American patients and associated with advanced HIV disease. ESRD incidence is lower in HIVICK patients compared with those with HIVAN. Unlike HIVAN, cART use was not associated with the incidence of ESRD in HIVICK.
authors.affiliation: Division of Internal Medicine, Louisiana State University Health Science Center, Baton Rouge, Louisiana, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Foy
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.forename: Faryal
authors.initials: F
authors.lastname: Tahir
authors.forename: Derek M
authors.initials: DM
authors.lastname: Fine
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Mohamed G
authors.initials: MG
authors.lastname: Atta
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology*; D000328:Adult; D001741:Black or African American; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D048909:Diabetes Complications; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006678:HIV / Q000235:genetics; D006801:Humans; D006973:Hypertension / Q000150:complications; D007105:Immune Complex Diseases / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology*; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology / Q000821:virology; D007676:Kidney Failure, Chronic / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D014481:United States; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral