AIDS (London, England) 2018 03 20() doi 10.1097/QAD.0000000000001807
Factors affecting kidney function and proteinuria among HIV+ and HIV- persons need better characterization.
We evaluated estimated glomerular filtration rate (eGFR, mL/min per 1.73 m) changes, proteinuria prevalence (a urine protein-to-creatinine ratio [UPCr] of ≥0.2 at two consecutive visits) and associated factors among HIV+ and HIV- men.
There were 917 HIV+ men receiving HAART, 159 HIV+ men not receiving HAART, and 1305 HIV- men seen from 10/2003 to 9/2014. Median annual eGFR change was -0.5%, -0.8% for HIV+ and -0.3% for HIV- men (p < 0.001). Factors significantly (p < 0.05) associated with >3% annual eGFR decline were: HAART receipt (but no specific ART drug), age>50, hypertension, diabetes, current smoking. Proteinuria existed in 14.9% of visit-pairs among HAART recipients, 5.8% among non-HAART recipients, and 1.9% among HIV- men, and was associated with subsequent annual >3% eGFR decline (OR 1.80, p < 0.001). Proteinuria-associated factors also included HAART use (vs. HIV-), age ≥50 (vs. < 40), diabetes, hypertension, current smoking, HCV-infection (all p < 0.05) and, among HIV+ men, lower CD4 cell count, didanosine, saquinavir, or nelfinavir use (all p < 0.05). After adjusting for proteinuria, among HAART users, having a detectable HIV RNA, cumulative use of tenofovir disoproxil fumarate (TDF), emtricitabine, ritonavir, atazanavir, any protease inhibitor, or fluconazole were associated with >3% annual eGFR decline.
Longitudinal kidney function decline was associated with HAART use but no individual ART drug, and traditional kidney disease risks. Proteinuria was nearly 7 times more common in HAART-treated men than HIV- men, reflected recent eGFR decline and predicted subsequent eGFR decline.