Antiretroviral therapy improves renal function among HIV-infected Ugandans

Peters, Philip J.; Moore, David; Mermin, Jonathan; Brooks, John T.; Downing, Robert; Were, Willy; Kigozi, Aminah; Weidle, Paul J.

doi:10.1038/ki.2008.305

Cited by 101 publications

(103 citation statements)

References 24 publications

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“…Significant GFR improvements were observed among subjects with baseline renal impairment who enrolled in the randomized DART trial that compared laboratory and clinical monitoring of initial ART to clinically driven monitoring alone, and such improvements also were evident among patients with CLcr<50 ml/min in Ugandans who enrolled in the Home-Based AIDS Care; greater GFR improvements were associated with greater baseline renal insufficiency in these studies [32,33]. In a multi-center longitudinal cohort study through the ACTG, suppression of HIV-1 viral load (by ≥1 log, or to <400 copies/mL) was associated with GFR improvements among subjects with stage ≥2 renal insufficiency and CD4 cell counts <200/μL at ART initiation [76], and GFR improvements (by cystatin-C) also were associated with ART-associated reductions in HIV-1 RNA in the FRAM study [77].…”

Section: Renal Benefits By Artmentioning

confidence: 73%

“…These studies describe wide variability in CKD prevalence among Africans living with HIV, ranging from 0.7% to 42% for GFR <60 ml/min/1.73 m 2 , including 0.7% to 18.9% in the largest studies [5,6,8,[32][33][34][35][36][37]. Proteinuria was detected in 6.1% to 23% of HIV-infected Africans, and lower CD4 cell counts were correlates of lower GFR and increased proteinuria in these studies.…”

Section: African Ancestry and Kidney Diseasementioning

confidence: 98%

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Kidney Disease in HIV-Infected Persons

Kalayjian

2011

Curr Infect Dis Rep

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Kidney disease is more prevalent among persons living with HIV, and may arise from a combination of comorbidities, co-infections, and medication-associated toxicities. Additional effects of HIV-1 viral replication, immunodeficiency and genetic factors also contribute to kidney disease. As is true in the general population, persons of African descent exhibit a disproportionate risk for severe kidney disease. Antiretroviral therapy (ART) modifies the natural history of HIV-associated nephropathy (HIVAN), and renal benefits of ART may not be limited to persons with HIVAN. Robust associations between proteinuria and cardiovascular disease imply that common mechanisms of vascular endothelial dysfunction may contribute to both processes.

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Section: Renal Benefits By Artmentioning

confidence: 73%

Section: African Ancestry and Kidney Diseasementioning

confidence: 98%

Kidney Disease in HIV-Infected Persons

Kalayjian

2011

Curr Infect Dis Rep

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“…ART was associated with significant GFR improvements among subjects with baseline renal impairment who enrolled in the DART trial, and such improvements also were evident among patients with CLcr<50 mL/min in Ugandans who enrolled in the Home-Based AIDS Care; in both of these studies, greater GFR improvements were associated with greater baseline renal insufficiency [15,16]. A trend toward a lower risk of ESRD was observed in the SMART study among subjects who were randomized to continue or initiate ART, in the viral suppression arm, versus discontinue or not start ART (for CD4 cell counts above 350 cells/μL), in the drug conservation arm (hazard ratio for ESRD in drug conservation vs viral suppression arm: 4.5 [95% CI 1.0-20.9], P=0.054) [44].…”

Section: Benefits Of Art On Kidney Diseasementioning

confidence: 82%

“…Using the Cockcroft-Gault formula, the prevalence of renal insufficiency at baseline ranged from 7.2% to 11.5% for moderate insufficiency (between 59 and 30 mL/min) ( Table 1) [12][13][14][15][16][17][18]. By comparison, 3.5% and 4.7% of subjects enrolled in the EuroSIDA cohort had moderate renal insufficiency when using the Cockcroft-Gault and the MDRD equations, respectively [19].…”

Section: Contributions By Race and Hepatitis C To Ckd In Persons Livimentioning

confidence: 99%

Renal Issues in HIV Infection

Kalayjian

2011

Curr HIV/AIDS Rep

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Kidney disease remains a prominent complication of HIV disease, despite beneficial effects of antiretroviral therapy on the natural history of HIV-associated nephropathy, and on kidney function in general populations of HIV infected patients. Persons of African descent continue to bear a disproportionate burden of severe kidney disease, as is true for the general population. Recently identified genetic variants in the apolipoprotein L1 gene may contribute to this burden. As is also true for the general population, markers of kidney disease, including microalbuminuria, are sensitive predictors of cardiovascular disease and mortality among persons living with HIV. The emerging experience with kidney transplantation also suggests this to be a viable option in selected patients.

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“…1 Introduction of antiretroviral treatment has significantly improved the prognosis of many kidney diseases associated both directly with HIV and with the influence of the virus on the immune system. [3][4][5] Antiretroviral therapy may, however, also lead to a number of side effects, including nephrotoxicity. Of course, different drugs can influence kidney function in various ways.…”

Section: Introductionmentioning

confidence: 99%

Urine Liver-Type Fatty Acid-Binding Protein and Kidney Injury Molecule-1 in HIV-Infected Patients Receiving Combined Antiretroviral Treatment Based on Tenofovir

Jabłonowska

Wójcik

Piekarska

2014

AIDS Research and Human Retroviruses

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The aim of this study was to determine the presence of kidney tubular damage in the absence of overt evidence of glomerular dysfunction (GFR > 60 ml/min without proteinuria) in HIV-infected patients receiving antiretroviral therapy. Urine kidney injury molecule-1 (KIM-1) and liver-type fatty acid-binding protein (L-FABP) levels were measured by ELISA and expressed as a ratio to creatinine. Sixty-six patients (median age 38 years) and 10 healthy controls (median age 35.5 years) were included in the study. Patients with chronic diseases such as diabetes, hypertension, heart disease, or kidney disease were excluded from the study. All patients received tenofovir/emtricitabine combined with one of three other components, namely efavirenz, atazanavir/norvir, or lopinavir/norvir. A lower concentration of L-FABP/creatinine was observed in HIV-infected as compared to healthy individuals ( p = 0.0353); KIM-1/creatinine was also lower in comparison with healthy controls but not statistically significantly. Patients receiving efavirenz had higher levels of L-FABP/creatinine in comparison to healthy controls ( p = 0.0039). Patients with anti-HCV had higher concentrations of L-FABP/creatinine as compared to the HIV-monoinfected individuals (not statistically significant) and to healthy subjects ( p = 0.0356). All four patients with L-FABP > 17.5 lg/g creatinine were HIV/HCV coinfected. On multivariate logistic regression urine L-FABP above 5.5 lg/g creatinine was independently associated with body weight (OR = 0.93 p = 0.039). This study suggests that HIV/HCV-coinfected patients with lower body weight treated with tenofovir may be at an increased risk of tubular dysfunction and should be monitored more closely. The use of protease inhibitors was not associated with an increased risk of tubular disorders.

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Antiretroviral therapy improves renal function among HIV-infected Ugandans

Cited by 101 publications

References 24 publications

Kidney Disease in HIV-Infected Persons

Kidney Disease in HIV-Infected Persons

Renal Issues in HIV Infection

Urine Liver-Type Fatty Acid-Binding Protein and Kidney Injury Molecule-1 in HIV-Infected Patients Receiving Combined Antiretroviral Treatment Based on Tenofovir

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