title: Trends in the outcomes of end-stage renal disease secondary to human immunodeficiency virus-associated nephropathy.
abstract: BACKGROUND
  Little is known about the trends in the incidence and outcomes of patients with end-stage renal disease (ESRD) attributed to human immunodeficiency virus-associated nephropathy (HIVAN). We sought to define relative incidence among ESRD patients, changes in mortality among patients with ESRD attributed to HIVAN, as well as changes in the excess mortality experienced by patients with ESRD attributed to HIVAN compared with otherwise similar ESRD patients with non-HIVAN causes.
  
  
  METHODS
  We used the US Renal Data System to identify all individuals with reported HIVAN who initiated treatment for ESRD between 1989 and 2011. We plotted their counts and proportions among all incident ESRD patients and tabulated their characteristics across years. We then compared mortality within the HIVAN group across years using Cox regression. In addition, we studied the trends in relative mortality of HIVAN patients versus those with ESRD not reported as HIVAN.
  
  
  RESULTS
  Overall, 14 719 individuals with HIVAN-ESRD were recorded, with significant reductions in recent years (893 in 2006; 525 in 2011). Compared with patients initiating dialysis between 1989 and 1992, mortality declined by 40% (HR = 0.60; 95% CI, 0.55-0.65) and 64% (HR = 0.36; 95% CI, 0.32-0.40) for patients initiating dialysis in 1999/2000 and 2009-11, respectively. The adjusted excess mortality of HIVAN-ESRD patients versus incident ESRD patients from other causes was >5-fold in 1989-92 (HR = 5.21; 95% CI, 4.84-5.60); this excess mortality has subsequently declined but remained at almost 3-fold in recent years (e.g. HR = 2.58; 95% CI, 2.37-2.80, 2009-11 incidence cohort).
  
  
  CONCLUSIONS
  Concurrent with the increasing availability of highly active antiretroviral therapy (HAART), both the incidence of ESRD due to HIVAN and the mortality of such patients have decreased substantially. However, HIVAN patients reaching ESRD continue to experience substantial excess mortality compared with other ESRD patients even in the current era of modern HAART.
authors.affiliation: Department of Medicine, Santa Clara Medical Center, Santa Clara, CA, USA Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Razzak Chaudhary
authors.affiliation: Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Biruh T
authors.initials: BT
authors.lastname: Workeneh
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Montez-Rath
authors.affiliation: Division of Infectious Disease and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA ViiV Healthcare, Inc., Brentford, Middlesex, UK.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Zolopa
authors.affiliation: Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Klotman
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology
keywords: AIDS; HAART; dialysis; mortality; outcome