Hepatitis C virus increases the risk of kidney disease among HIV-positive patients: Systematic review and meta-analysis.
Kidney disease has become an important co-morbidity among human immunodeficiency virus-infected patients as they live longer in the era of highly effective antiretroviral therapy. It remains unclear how co-infection with hepatitis C virus impacts on the trajectory of kidney disease among HIV-infected patients. To evaluate the effect of co-infection with HCV on the risk of kidney disease in HIV-infected populations. We conducted a systematic review of the published medical literature to determine if hepatitis C co-infection is associated with increased likelihood of chronic kidney disease in HIV-positive adults. We used the random effects model of DerSimonian and Laird to generate a summary estimate of the relative risk for chronic kidney disease (defined by reduced glomerular filtration rate and/or detectable proteinuria) with hepatitis C virus across the published studies. Meta-regression and stratified analysis were also conducted. We identified 19 studies (146,151 unique patients with HIV) and separate meta-analyses were performed according to the outcome. Aggregation of longitudinal studies (n = 8, 105,462 unique patients) showed a relationship between HCV infection and increased risk of reduced glomerular filtration rate among HIV-infected individuals, the summary estimate for adjusted hazard ratio was 1.64 (95%CI, 1.28; 2.0, P < 0.001) in HIV-HCV co-infected individuals compared with those having HIV mono-infection. No between-studies heterogeneity was noted (P-value by Q test = 0.08). HCV positive serology was an independent risk factor for proteinuria; adjusted effect estimate, 1.23 (95% confidence interval, 1.18; 1.28, P = 0.001) (n = 6 studies; 26,835 unique patients). In meta-regression, we noted the impact of ageing (P = 0.0001) upon the adjusted hazard ratio of incidence of reduced glomerular filtration rate among HCV-HIV co-infected patients; a negative association between frequency of males (P = 0.001) and the adjusted hazard ratio of prevalence of low glomerular filtration rate was found. Hepatitis C co-infection is associated with a significant increase in the risk of reduced glomerular filtration rate and/or detectable proteinuria among HIV-infected individuals.
Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Milano, Italy.|Division of Hepatology, School of Medicine, University of Miami, Miami, Florida.
Fabrizio
F
Fabrizi
Division of Hepatology, School of Medicine, University of Miami, Miami, Florida.
Vivek
V
Dixit
Division of Hepatology, School of Medicine, University of Miami, Miami, Florida.
Paul
P
Martin
Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Milano, Italy.
Piergiorgio
P
Messa
D000328:Adult; D000367:Age Factors; D060085:Coinfection / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D016174:Hepacivirus / Q000502:physiology; D006526:Hepatitis C / Q000150:complications* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D011507:Proteinuria / Q000209:etiology / Q000821:virology; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000821:virology; D012307:Risk Factors; D012737:Sex Factors
chronic kidney disease; glomerular filtration rate; hepatitis C virus; human immunodeficiency virus; proteinuria