title: Albuminuria Is Associated with Traditional Cardiovascular Risk Factors and Viral Load in HIV-Infected Patients in Rural South Africa.
abstract: BACKGROUND
  As life expectancy improves among Human Immunodeficiency Virus (HIV) patients, renal and cardiovascular diseases are increasingly prevalent in this population. Renal and cardiovascular disease are mutual risk factors and are characterized by albuminuria. Understanding the interactions between HIV, cardiovascular risk factors and renal disease is the first step in tackling this new therapeutic frontier in HIV.
  
  
  METHODS
  In a rural primary health care centre, 903 HIV-infected adult patients were randomly selected and data on HIV-infection and cardiovascular risk factors were collected. Glomerular filtration rate (eGFR) was estimated. Albuminuria was defined as an Albumin-Creatinine-Ratio above 30 mg/g. Multivariate logistic regression analysis was used to analyse albuminuria and demographic, clinical and HIV-associated variables.
  
  
  RESULTS
  The study population consisted of 903 HIV-infected patients, with a median age of 40 years (Inter-Quartile Range (IQR) 34-48 years), and included 625 (69%) women. The median duration since HIV diagnosis was 26 months (IQR 12-58 months) and 787 (87%) received antiretroviral therapy. Thirty-six (4%) of the subjects were shown to have diabetes and 205 (23%) hypertension. In the cohort, 21% had albuminuria and 2% an eGFR <60 mL/min/1.73m2. Albuminuria was associated with hypertension (adjusted odds ratio (aOR) 1.59; 95% confidence interval (CI) 1.05-2.41; p<0.05), total cholesterol (aOR 1.31; 95% CI 1.11-1.54; p<0.05), eGFR (aOR 0.98; 95% CI 0.97-0.99; p<0.001) and detectable viral load (aOR 2.74; 95% CI 1.56-4.79; p<0.001). Hypertension was undertreated: 78% were not receiving treatment, while another 11% were inadequately treated. No patients were receiving lipid-lowering medication.
  
  
  CONCLUSIONS
  Glomerular filtration rate was well conserved, while albuminuria was common amongst HIV-infected patients in rural South Africa. Both cardiovascular and HIV-specific variables were associated with albuminuria. Improved cardiovascular risk prevention as well as adequate virus suppression might be the key to escape the vicious circle of renal failure and cardiovascular disease and improve the long-term prognosis of HIV-infected patients.
authors: Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands.
authors: G Emerens
authors: GE
authors: Wensink
authors: Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands.
authors: Annelot F
authors: AF
authors: Schoffelen
authors: Ndlovu Care Group in Elandsdoorn, Limpopo, South Africa.
authors: Hugo A
authors: HA
authors: Tempelman
authors: Department of Nephrology & Hypertension at the University Medical Centre in Utrecht, Utrecht, The Netherlands.
authors: Maarten B
authors: MB
authors: Rookmaaker
authors: Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands.
authors: Andy I M
authors: AI
authors: Hoepelman
authors: Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands.
authors: Roos E
authors: RE
authors: Barth
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy / Q000652:urine*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012423:Rural Health; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D003404:Creatinine