title: Hepatitis C co-infection is associated with an increased risk of incident chronic kidney disease in HIV-infected patients initiating combination antiretroviral therapy.
abstract: Combination antiretroviral therapy (cART) has reduced mortality from AIDS-related illnesses and chronic comorbidities have become prevalent among HIV-infected patients. We examined the association between hepatitis C virus (HCV) co-infection and chronic kidney disease (CKD) among patients initiating modern antiretroviral therapy.
  
  
  
  Data were obtained from the Canadian HIV Observational Cohort for individuals initiating cART from 2000 to 2012. Incident CKD was defined as two consecutive serum creatinine-based estimated glomerular filtration (eGFR) measurements <60 mL/min/1.73m2obtained ≥3 months apart. CKD incidence rates after cART initiation were compared between HCV co-infected and HIV mono-infected patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression.
  
  
  
  We included 2595 HIV-infected patients with eGFR >60 mL/min/1.73m2at cART initiation, of which 19% were HCV co-infected. One hundred and fifty patients developed CKD during 10,903 person-years of follow-up (PYFU). The CKD incidence rate was higher among co-infected than HIV mono-infected patients (26.0 per 1000 PYFU vs. 10.7 per 1000 PYFU). After adjusting for demographics, virologic parameters and traditional CKD risk factors, HCV co-infection was associated with a significantly shorter time to incident CKD (HR 1.97; 95% CI: 1.33, 2.90). Additional factors associated with incident CKD were female sex, increasing age after 40 years, lower baseline eGFR below 100 mL/min/1.73m2, increasing HIV viral load and cumulative exposure to tenofovir and lopinavir.
  
  
  
  HCV co-infection was associated with an increased risk of incident CKD among HIV-infected patients initiating cART. HCV-HIV co-infected patients should be monitored for kidney disease and may benefit from available HCV treatments.
authors.affiliation: Research Institute of the McGill University Health Centre, Montréal, Canada.
authors.forename: Carmine
authors.initials: C
authors.lastname: Rossi
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.affiliation: Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Walmsley
authors.affiliation: The Ottawa Hospital, General Campus, Ottawa, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.affiliation: St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou
authors.affiliation: St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Burchell
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Hull
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Chia
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.|Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada.
authors.forename: Erica E M
authors.initials: EE
authors.lastname: Moodie
authors.affiliation: Research Institute of the McGill University Health Centre, Montréal, Canada. marina.klein@mcgill.ca.|Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montréal, H4A 3J1, Canada. marina.klein@mcgill.ca.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000209:etiology*; D012307:Risk Factors
keywords: Antiretroviral therapy; Chronic kidney disease; Co-infection; Glomerular filtration; HIV; Hepatitis C