Background:  HIV-infected African Americans are at high risk for chronic kidney disease. However, little is known about how rates of end stage renal disease (ESRD) have changed as treatment for HIV has improved.

Methods:  Participants in 2 Baltimore-based, predominantly African American cohort studies were included in this analysis:  the Johns Hopkins HIV Cohort, a clinic-based cohort of HIV-infected participants, and the ALIVE study, a community-based cohort of HIV⁺ and HIV^– injection drug users. ESRD was defined as the dialysis initiation date recorded by the U.S. Renal Data System. The event rate was calculated as incident ESRD cases divided by person-years of follow-up in subjects who were free of ESRD at enrollment. The analysis was restricted to African Americans because ESRD occurred predominantly in this group. Poisson regression and incidence rate ratios (IRR) were used to express relative risk.

Results:  Between 1990 and 2005, 6255 African American participants (31% female, 28% HIV-negative, median age 37) contributed 35,910 person-years of observation. Of these, 221 developed ESRD (6.2 per 1000 person-years). Compared to HIV^– subjects, the risk of ESRD was significantly higher in HIV⁺ subjects without AIDS (IRR 2.3, 95%CI 1.5 to 3.5), and in subjects with AIDS (IRR 5.1, 95%CI 3.5 to 7.6). In HIV⁺ participants, the risk of ESRD was 11.9-fold higher (95% I 10.2 to 13.7) than predicted from age- and race-stratified rates in the U.S. population. In HIV⁺ participants, the risk of ESRD increased over calendar time, after adjustment for age and AIDS status (see the table).

Conclusions:   The ESRD rate is high in HIV-infected African Americans and does not appear to have decreased with the widespread use of HAART. It is unknown if these changes in ESRD incidence reflect changes in the underlying pathologic etiologies of chronic kidney disease in this population.