12th CROI Abstract #821

Session 142 Poster Abstracts
Renal and Bone Abnormalities
Thursday, 1:30 - 3:30 pm
Hall B

821

HIV is Associated with Increased Prevalence of Microalbuminuria
L Szczech¹, Carl Grunfeld*^2,5, J Canchola³, S Sydney⁴, and M Shlipak^2,5
¹Duke Univ Med Ctr, Durham, NC, USA; ²Univ of California, San Francisco, USA; ³Univ of California, San Francisco, USA; ⁴Kaiser Northern California Div of Res, Oakland, USA; and ⁵San Francisco VA Med Ctr, CA, USA

Background: Microalbuminuria (MA) as a marker of renal disease is associated with increased risk of cardiovascular disease and mortality in the general population, and is frequently seen among patients with HIV infection. African Americans have a greater risk of renal disease than the general population and are disproportionately represented among patients infected with HIV. To determine how MA correlates with HIV and race, we compared the prevalence of MA in the Fat Redistribution and Metabolic Change in HIV Infection Study (FRAM) cohort of HIV-infected patients with the non-HIV-infected control men (CON) from the Coronary Artery Risk development in Young Adults (CARDIA) Study.

Methods: Urine albumin and creatinine (ARC) levels were measured in HIV and CON patients. Urine ACR was determined, and MA was defined as an ACR > 30mg/g. Multivariate logistic regression was used to determine the independent association of HIV infection with MA and to evaluate independent predictors of MA within HIV-positive patients .

Results: Among the 1027 HIV patients, the mean age was 43 ą 9; 70% were men, 45% were African American, and 55% were white. Among 303 CON, the mean age was 40 ą 4; 52% were men, and 48% were African American. MA was present in 83 (8%) of HIV patients, but only 5 (2%) of controls (p < 0.001). After multivariate adjustment for age, race, sex, systolic blood pressure (SBP), and triglyceride levels, HIV infection retained an independent association with prevalent MA (adjusted odds ratio (OR) 4.5; 95% confidence interval [CI], 2.0 to 13.2). We found similar results when we repeated the analysis using a cut off for MA of ACR < 17mg/g in women and ACR < 26mg/g in men; MA prevalence was 10% of HIV patients and 5% of CON, with an adjusted OR of 2.1 (1.2 to 3.9). Among HIV patients, independent predictors of MA included SBP categories (OR 1.0, 2.0 [1.2 to 3.2], and 5.0 [0.9 to 28.7] for SBP < 120, 120 to 139, and > 140, respectively, and African American 2.1; 1.2 to 3.5).

Conclusion: HIV has a strong and independent association with MA. HIV patients who are African American or who have elevated SBP are at particularly high risk. The increased prevalence of MA in HIV could portend increased risk for cardiovascular and renal complications.

Keywords: HIV; Microalbuminuria; Race