Prevalence and Factors Associated with Renal Dysfunction Among HIV-Infected Patients
NAVAL MEDICAL CENTER SAN DIEGO CA
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Renal dysfunction is an increasingly recognized non-AIDS--defining comorbidity among HIV -infected persons. The role of HIV-related factors in renal dysfunction remains unclear. We performed a cross-sectional study at two military clinics with open access to care to determine the impact of HIV factors, including antiretroviral therapy, on renal function. Renal dysfunction was defined as a glomerular filtration rate GFR 60 mLmin 1.73 m . We evaluated 717 HIV patients with a median age of 41 years 92 were male, 49 Caucasian, and 38 African American median CD4 count was 515cellsmm3 and 73 were receiving highly active antiretroviral therapy HAART. Twenty-two patients 3 had renal dysfunction. Factors associated with renal dysfunction in the multivariate logistic analyses included older age odds ratio OR 2.0 per 10 year increase, p 0.006, lower CD4 nadir OR 0.6 per 100 cell change, p 0.02, and duration of tenofovir use OR 1.5 per year use, p 0.01. Amony persons initiating tenofovir n 241, 50 experienced a reduction in GFR median -10.5mLmin 1.73 m , 95 CI, -8.9 to -13.3 within 2 years. Among tenofovir users, factors associated with a reduction in GFR included female gender p 0.001, African American ethnicity p 0.003, and lower CD4 nadir p 0.002. In summary, renal dysfunction was relatively uncommon among our HIV-infected patients, perhaps due to their young age, lack of comorbidities, or as a result of our definition that did not include proteinuria. Renal dysfunction was associated with duration of tenofovir use. Factors associated with renal loss among tenofovir users included female gender, African American ethnicity, and CD4 nadir 200cellsmm3 . Consideration for more frequent monitoring of kidney function among these select HIV patients may be warranted.
- Medicine and Medical Research