title: HIV therapy, metabolic and cardiovascular health are associated with glomerular hyperfiltration among men with and without HIV infection.
abstract: OBJECTIVE
  Diabetes and hypertension, common conditions in antiretroviral-treated HIV-infected individuals, are associated with glomerular hyperfiltration, which precedes the onset of proteinuria and accelerated kidney function decline. In the Multicenter AIDS Cohort Study, we examined the extent to which hyperfiltration is present and associated with metabolic, cardiovascular, HIV and treatment risk factors among HIV-infected men.
  
  
  METHODS
  Cross-sectional cohort using direct measurement of glomerular filtration rate by iohexol plasma clearance for 367 HIV-infected men and 241 HIV-uninfected men who were free of chronic kidney disease.
  
  
  METHODS
  Hyperfiltration was defined as glomerular filtration rate above 140-1 ml/min per 1.73 m per year over age 40. Multivariate logistic regression was used to estimate the odds ratios (ORs) of prevalent hyperfiltration for metabolic, cardiovascular, HIV and cumulative antiretroviral exposure factors.
  
  
  RESULTS
  Among individuals without chronic kidney disease, the prevalence of hyperfiltration was higher for HIV-infected participants (25%) compared to uninfected participants (17%; P = 0.01). After adjustment, HIV infection remained associated with hyperfiltration [OR 1.70, 95% confidence interval (CI) 1.11-2.61] and modified the association between diabetes and hyperfiltration, such that the association among HIV-uninfected men (OR 2.56, 95% CI 1.33-5.54) was not observed among HIV-infected men (OR 1.19, 95% CI 0.69-2.05). These associations were independent of known risk factors for hyperfiltration. Indicators of hyperglycemia and hypertension were also associated with hyperfiltration as was cumulative zidovudine exposure.
  
  
  CONCLUSIONS
  Hyperfiltration, a potential modifiable predictor of kidney disease progression, is significantly higher among antiretroviral-treated HIV-infected men. Furthermore, HIV-infection nullifies the association of diabetes and hyperfiltration present in HIV-uninfected men.
authors.affiliation: aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health bDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland cDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois dGraduate School of Public Health, Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania eLos Angeles Gay and Lesbian Center, Los Angeles, California fWelch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland gDepartment of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: Derek K
authors.initials: DK
authors.lastname: Ng
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Martinson
authors.forename: Robert
authors.initials: R
authors.lastname: Bolan
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.forename: George J
authors.initials: GJ
authors.lastname: Schwartz
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005919:Glomerular Filtration Rate; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy*; D006262:Health; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology*; D007678:Kidney Glomerulus / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents