HIV and Proteinuria in an Injection Drug User Population

Abstract

Background and objectives: Proteinuria is a major determinant of chronic kidney disease. We aimed to characterize the prevalence and correlates of proteinuria in a cohort of HIV-infected and uninfected injection drug users.Design, setting, participants, & measurements: A cross-sectional analysis was performed among 902 injection drug users (273 HIV-infected) in the AIDS Linked to the Intravenous Experience cohort. The primary outcome was proteinuria defined as having a urine protein/creatinine concentration ratio >200 mg/g. Poisson regression with robust variance was used to determine prevalence ratios.Results: Overall, 24.8% of participants had proteinuria; the prevalence was 2.9 times higher among HIV-infected participants (45%) compared with HIV-uninfected participants (16%). In addition, age, health insurance, employment status, hepatitis B and C serostatus, diabetes, and high BP were associated with proteinuria. Neither antiretroviral therapy nor features of illicit drug use history were associated with proteinuria. In multivariate analysis, HIV infection, unemployment, increased age, diabetes, hepatitis C infection, and high BP were significantly associated with a higher prevalence of proteinuria.Conclusions: In an aging, predominantly African-American cohort of injection drug users, we found a striking burden of proteinuria that was strongly associated with HIV status. In addition to being a pathway to ESRD, proteinuria is a potent risk factor for cardiovascular morbidity and mortality. Evaluation of aggressive screening and disease-modification strategies in this high-risk population is warranted.

Hepatitis C Virus Infection Increases the Risk of Developing Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“…Two studies defined proteinuria by standard dipstick urinalysis [30,33], and four measured albuminuria by spot urine albumin/creatinine ratio [27,29,32,34]. The summary estimate for adjusted OR of proteinuria with HCV was 1.508 (95 % CI 1.19; 1.89, P = 0.0001) across the identified studies (Fig.…”

“…The studies were published in 17 various articles [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and carried out in 4 countries ( Fig. 1) (n = 2,842,421 unique patients).…”

“…Six studies (n = 107,356 unique patients, 7413 (6.9 %) being anti-HCV seropositive and 99,943 anti-HCV negative) [27,29,30,[32][33][34] evaluated the prevalence of proteinuria according to anti-HCV-positive serologic status. Two studies defined proteinuria by standard dipstick urinalysis [30,33], and four measured albuminuria by spot urine albumin/creatinine ratio [27,29,32,34].…”

“…Meta-regression showed a positive relationship between frequency of males and prevalence of proteinuria (P = 0.0026); a negative association between study size (P = 0.0005) and age (P = 0.00001) on the frequency of proteinuria was found (Table 7). We calculated the unadjusted OR of the prevalence of proteinuria among anti-HCV-positive patients, as an additional sensitivity analysis [27,29,30,[32][33][34][35].…”

Prevalence of Proteinuria and Elevated Serum Cystatin C among HIV-Infected Adolescents in the Reaching for Excellence in Adolescent Care and Health (REACH) Study

“…The prevalence of proteinuria in adults in the general population in the US ranges from 6–10%, 14,15 while various studies in the US and abroad have demonstrated a higher prevalence of proteinuria in HIV-infected adults ranging from 17–45% 16,17 and 21–33% in children. 18,19 Likewise, due to the significant limitations of serum creatinine-based glomerular filtration rate (GFR) estimation in individuals with HIV, serum cystatin C has emerged as a marker for both the evaluation of GFR and the detection of drug-induced kidney injury.…”