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Long-term kidney function, proteinuria, and associated risks among HIV-infected and uninfected men.

Long-term kidney function, proteinuria, and associated risks among HIV-infected and uninfected men.
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Palella F, Li X, Gupta SK, Estrella MM, Phair JP, Margolick JB, Detels R, Kingsley L, Jacobson LP,


Palella F, Li X, Gupta SK, Estrella MM, Phair JP, Margolick JB, Detels R, Kingsley L, Jacobson LP, (click to view)

Palella F, Li X, Gupta SK, Estrella MM, Phair JP, Margolick JB, Detels R, Kingsley L, Jacobson LP,

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AIDS (London, England) 2018 03 20() doi 10.1097/QAD.0000000000001807

Abstract
BACKGROUND
Factors affecting kidney function and proteinuria among HIV+ and HIV- persons need better characterization.

METHODS
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.

RESULTS
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.

CONCLUSIONS
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.

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