Hepatitis C Viremia and the Risk of Chronic Kidney Disease in HIV-Infected Individuals

Lucas, Gregory M.; Jing, Yuezhou; Sulkowski, Mark S.; Abraham, Alison G.; Estrella, Michelle M.; Atta, Mohamed G.; Fine, Derek M.; Klein, Marina B.; Silverberg, Michael J.; Gill, M. John; Moore, Richard D.; Gebo, Kelly A.; Sterling, Timothy R.; Butt, Adeel A.; Kirk, Gregory D.; Benson, Constance A.; Bosch, Ronald J.; Collier, Ann C.; Boswell, Stephen L.; Grasso, Chris; Mayer, Ken; Hogg, Robert S.; Harrigan, Richard; Montaner, Julio S. G.; Cescon, Angela; Buchacz, Kate; Carey, John T.; Rodrı́guez, Benigno; Horberg, Michael A.; Thorne, Jennifer E.; Goedert, James J.; Jacobson, Lisa P.; Rourke, Sean B.; Burchell, Ann; Rachlis, Anita; Rico, Puerto; Hunter-Mellado, Robert F.; Mayor, Ángel M.; Deeks, Steven G.; Martin, Jeffrey N.; Patel, Pragna; Brooks, John T.; Mugavero, Michael J.; Willig, James H.; Eron, Joseph J.; Napravnik, Sonia; Dubrow, Robert; Fiellin, David A.; Haas, David W.; Bebawy, Sally; Turner, Megan; Anastos, Kathryn; Saag, Michael S.; McKaig, Rosemary G.; Justice, Amy C.; Freeman, Aimee; Lent, Carol; Kitahata, Mari M.; Rompaey, Stephen E. Van; Crane, Heidi M.; Webster, Eric; Morton, Liz; Simon, Brenda; Gange, Stephen J.; Althoff, Keri N.; Lau, Bryan; Zhang, Jinbing; Jing, Jerry; Golub, Elizabeth T.; Modur, Shari; Hanna, David B.; Rebeiro, Peter F; Wong, Chung F.; Mendes, Adell

doi:10.1093/infdis/jit373

Cited by 44 publications

(45 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We did not have HCV RNA data to confirm chronic HCV infection, and it is likely that hepatitis C resolved in some patients. However, the NA-ACCORD study recently reported that individuals who were HCV Ab positive but HCV RNA negative also had an increased risk for CKD similar to individuals who were HCVAb and RNA positive [30]. In addition, our results may not generalize to nonveterans, women, children or patients not receiving regular clinical care.…”

Section: Discussionmentioning

confidence: 70%

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

Scherzer

Gandhi

Estrella

et al. 2014

Aids

Self Cite

View full text Add to dashboard Cite

Objective Tenofovir disoproxil fumarate is a widely used antiretroviral for HIV infection that has been associated with an increased risk of chronic kidney disease (CKD). Our objective was to derive a scoring system to predict 5-year risk of developing CKD in HIV-infected individuals and to estimate difference in risk associated with tenofovir use. Design We evaluated time to first occurrence of CKD (estimated glomerular filtration rate <60 ml/min per 1.73 m2) in 21 590 HIV-infected men from the Veterans Health Administration initiating antiretroviral therapy from 1997 to 2010. Methods We developed a point-based score using multivariable Cox regression models. Median follow-up was 6.3 years, during which 2059 CKD events occurred. Results Dominant contributors to the CKD risk score were traditional kidney risk factors (age, glucose, SBP, hypertension, triglycerides, proteinuria); CD4+ cell count was also a component, but not HIV RNA. The overall 5-year event rate was 7.7% in tenofovir users and 3.8% in nonusers [overall adjusted hazard ratio 2.0, 95% confidence interval (CI) 1.8–2.2]. There was a progressive increase in 5-year CKD risk, ranging from less than 1% (zero points) to 16% (≥9 points) in nonusers of tenofovir, and from 1.4 to 21.4% among tenofovir users. The estimated number-needed-to-harm (NNH) for tenofovir use ranged from 108 for those with zero points to 20 for persons with at least nine points. Among tenofovir users with at least 1 year exposure, NNH ranged from 68 (zero points) to five (≥9 points). Conclusion The CKD risk score can be used to predict an HIV-infected individual’s absolute risk of developing CKD over 5 years and may facilitate clinical decision-making around tenofovir use.

show abstract

Section: Discussionmentioning

confidence: 70%

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

Scherzer

Gandhi

Estrella

et al. 2014

Aids

Self Cite

View full text Add to dashboard Cite

show abstract

“…The majority of previous studies of HCV and kidney disease outcomes have defined HCV based on antibody status, and studies evaluating the independent effect of HCV viremia have yielded conflicting results. (15,16) Nonetheless, the sensitivity of ICD-9-CM codes for the diagnosis of HCV infection has not been well established. Although a study in the US Veterans Affairs Health System demonstrated reasonable positive and negative predictive value to identify patients with a known diagnosis of HCV infection, that study included both inpatient and outpatient data from the longitudinal patient record.…”

Section: Discussionmentioning

confidence: 99%

Dialysis‐requiring acute kidney injury among hospitalized adults with documented hepatitis C Virus infection: a nationwide inpatient sample analysis

Nadkarni

Patel

Simoes

et al. 2015

Journal of Viral Hepatitis

View full text Add to dashboard Cite

Chronic Hepatitis C virus (HCV) infection may cause kidney injury, particularly in the setting of cryoglobulinemia or cirrhosis; however, few studies have evaluated the epidemiology of acute kidney injury in patients with HCV. We aimed to describe national temporal trends of incidence and impact of severe AKI requiring renal replacement (“dialysis-requiring AKI”) in hospitalized adults with HCV. We extracted our study cohort from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project using data from 2004–2012. We defined HCV and dialysis-requiring acute kidney injury based on previously validated ICD-9-CM codes. We analyzed temporal changes in the proportion of hospitalizations complicated by dialysis-requiring AKI and utilized survey multivariable logistic regression models to estimate its impact on in-hospital mortality. We identified a total of 4,603,718 adult hospitalizations with an associated diagnosis of HCV from 2004–2012, of which 51,434 (1.12%) were complicated by dialysis-requiring acute kidney injury. The proportion of hospitalizations complicated by dialysis-requiring acute kidney injury increased significantly from 0.86% in 2004 to 1.28% in 2012. In-hospital mortality was significantly higher in hospitalizations complicated by dialysis-requiring acute kidney injury vs. those without (27.38% vs. 2.95%; adjusted odds ratio 2.09, 95% Confidence Interval 1.74–2.51). The proportion of HCV hospitalizations complicated by dialysis-requiring acute kidney injury increased significantly between 2004–2012. Similar to observations in the general population, dialysis-requiring acute kidney injury was associated with a two-fold increase in odds of in-hospital mortality in adults with HCV. These results highlight the burden of acute kidney injury in hospitalized adults with HCV infection.

show abstract

“…In ESRD patients on maintenance dialysis, the prevalence of HCV increases with dialysis duration [16] , potentially due to transmission from blood products or contaminated equipment [11] . Additionally, certain populations are at increased risk of both diseases, including those with human immunodeficiency virus (HIV) and those who engage in intravenous drug use [17] . The presence of both HCV and CKD can make treatment difficult [11,18,19] due to tolerance and exacerbations associated with certain treatments [20,21] .…”

mentioning

confidence: 99%

Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost

Solid

Peter

Natwick

et al. 2017

Nephron

View full text Add to dashboard Cite

Background/Aims: Few studies explore the magnitude of the disease burden and health care utilization imposed by renal disease among patients with hepatitis C virus (HCV). We aimed to describe the characteristics, outcomes, and health care utilization and costs of patients with HCV with and without renal impairment. Methods: This retrospective analysis used 2 administrative claims databases: the US commercially insured population in Truven Health MarketScan® data (aged 20-64 years), and the US Medicare fee-for-service population in the Medicare 20% sample (aged ≥65 years). Baseline characteristics and comorbid conditions were identified from claims during 2011; patients were followed for up to 1 year (beginning January 1, 2012) to identify health outcomes of interest and health care utilization and costs. Results: In the MarketScan and Medicare databases, 35,965 and 10,608 patients with HCV were identified, 8.5 and 26.5% with evidence of renal disease (chronic kidney disease [CKD] or end-stage renal disease [ESRD]). Most comorbid conditions and unadjusted outcome rates increased across groups from patients with no evidence of renal disease to non-ESRD CKD to ESRD. Health care utilization followed a similar pattern, as did the costs. Conclusions: Our findings suggest that HCV patients with concurrent renal disease have significantly more comorbidity, a higher likelihood of negative health outcomes, and higher health care utilization and costs.

show abstract

Hepatitis C Viremia and the Risk of Chronic Kidney Disease in HIV-Infected Individuals

Abstract: Compared with HIV-infected subjects who were HCV seronegative, both HCV viremic and HCV aviremic individuals were at increased risk for moderate and advanced CKD.

Cited by 44 publications

References 36 publications

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

Dialysis‐requiring acute kidney injury among hospitalized adults with documented hepatitis C Virus infection: a nationwide inpatient sample analysis

Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost

Contact Info

Product

Resources

About