Session 87Poster Presentations HIV-Associated Nephropathy Session Day and Time: Tuesday 1:30 - 3:30 pm Room: Hall B
709 The Effect of Antiretroviral Therapy on the Incidence of HIV-associated Nephropathy: A 12-year Urban Cohort Study G. M. Lucas*1, J. A. Eustace1, E. K. Mentari1, K. Appiah2, S. Sozio1, R.D. Moore1 1Johns Hopkins Univ, Baltimore, MD and 2Good Samaritan Hosp, Baltimore, MD
Background: HIV-associated Nephropathy (HIVAN) is a kidney disease, occurring predominantly in patients (pts) of African or Haitian descent, which is characterized by nephrotic range proteinuria and rapid progression to end-stage renal disease. It has been postulated that the burden of HIVAN will increase as African Americans are disproportionately affected by the HIV epidemic and the life expectancy of HIV-infected individuals has increased markedly with highly active antiretroviral therapy (HAART). However, there are few data on the effect of antiretroviral therapy on HIVAN incidence.
Methods: Renal complications were recorded by trained study technicians from 1989 until present in the Johns Hopkins HIV cohort. We reviewed medical and pathological records of all potential HIVAN cases. HIVAN was defined by biopsy, or clinically as 1) proteinuria > 3g/24h; 2) progressive renal dysfunction; and 3) the absence of a major competing diagnosis. Longitudinal analysis was conducted with incidence rates and person-years (pys). Poisson regression was used for multi-variate analysis. Sex, race, and HIV risk group were including in the analysis as fixed covariates. Age > 40 yrs, calendar time, antiretroviral use, and CDC-defined AIDS were included as time-dependent co-variates.
Results: Over 11,731 pys of follow-up, 94 cases meeting criteria for HIVAN were documented, for an overall rate of 8.0/1,000 pys. HIVAN occurred predominantly in African Americans (rate 10.1 vs 1.1/1,000 pys in whites, p < 0.001). Sex, age, and HIV exposure category were not significantly associated with HIVAN risk. HIVAN incidence was stable at 9.2/1,000 pys from 1989-1997, but declined to 5.9/1,000 pys in 1998-2001 (p = 0.05). Among non-AIDS-defined pts, the HIVAN rate was 2.6/1,000 pys in pts not receiving antiretroviral therapy, 5.0/1,000 pys for pts on nucleoside reverse transcriptase inhibitors (NRTI), and 0.0/1,000 pys for pts on HAART (p = 0.01 for trend). The corresponding HIVAN rates for AIDS pts were 26.3/1,000 pys for pts not receiving antiretroviral therapy, 14.4/1,000 pys for pts on NRTI, and 6.8/1,000 pys for pts on HAART (< 0.001 for trend).
Conclusions: The incidence of HIVAN has declined in the last 3 yrs as a result of HAART use. Additional follow-up will be necessary to determine the long-term risk of HIVAN with HAART treatment, particularly when viremia is intermittently or incompletely controlled.
