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


818    
Chronic Kidney Disease and the Use of HAART
Ronald Reisler*1, L Jacobson2, S Gupta3, W Qiao2, J Margolick2, S Riddler4, B Visscher5, C Williams6, and F Palella7
1Inst of Human Virology, Univ of Maryland, Baltimore, USA; 2Johns Hopkins Univ, Bloomberg Sch of Publ Hlth, Baltimore, MD, USA; 3Indiana Univ Sch of Med, Indianapolis, USA; 4Univ of Pittsburgh Grad Sch of Publ Hlth, PA, USA; 5Univ of California, Los Angeles, Sch of Publ Hlth, USA; 6DAIDS, NIAID, NIH, DHHS, Bethesda, MD, USA; and 7Northwestern Univ Feinberg Sch of Med, Chicago, IL, USA

Background:  HIV-infected individuals with worsening renal function have an increasing risk of progression to AIDS and death. The prevalence and predictors of chronic kidney disease (CKD) in HIV-infected individuals have not been well defined.

Methods:  We examined the prevalence and predictors of CKD in a cross sectional analysis of 1470 HIV-infected and uninfected men enrolled in the Multicenter AIDS Cohort Study, using data collected from men who had serum creatinine measurements obtained at follow-up visit 40 (October 2003 to March 2004). Subjects’ glomerular filtration rates (GFR) were estimated using the simplified modification of diet in renal disease (MDRD) equation, which incorporates age and race; this then allowed CKD staging using the accepted NIH/NIDDK Kidney Disease Outcomes Quality Initiative standards. We performed multivariate logistic regression analyses to assess relationships between HIV status, HAART use (while controlling for pre-HAART HIV-1 RNA level, pre-HAART CD4 cell count, hypertension, diabetes mellitus, smoking, and body mass index), and the presence of more advanced CKD stage. Associations between the recent use of tenofovir and CKD stage were also investigated.

Results:  HAART-using infected men were more likely to have GFR < 60 mL/min/1.73 m2 (stages 3 to 5 CKD) compared to uninfected men (adjusted odds ratio (AOR) = 2.5, 95% CI = 1.4 to 4.5) but did not differ for having 60 < GFR < 89 mL/min/1.73 m2 (stage 2 CKD). More HIV-infected HAART users had GFR < 90 mL/min/1.73 m2 than HIV-infected HAART-naïve men (AOR = 1.7, 95% CI = 1.1 to 2.7). Pre-HAART HIV-1 RNA level and pre-HAART CD4 cell count were not associated with GFR. However, restricting the analysis to HAART users, use of tenofovir was associated with lower GFR than in non-users, yielding an OR = 1.7 (95% CI = 1.1 to 2.5) for stage 2 CKD and an OR = 2.0 (95% CI = 0.8 to 4.9) for stages 3-5 CKD. Length of time since initiation of HAART did not diminish these associations.

Conclusions:  Advanced CKD is significantly more common among HIV-infected men on HAART as compared to HIV-uninfected men. Decreased GFR in HAART users was not associated with pre-HAART HIV-1 RNA level or pre-HAART CD4 cell count. The association seen between tenofovir and lower GFR warrants additional investigation.

Keywords: kidney; HAART; glomerular filtration rate