Cumulative viral load was associated with increased risk of kidney disease, suggesting that early viral suppression could decrease incidence of disease.
Thanks to antiretroviral therapy (ART), people living with HIV continue to have lifespans comparable to those without infection. However, with longer lifespans and compromised immune function, people living with HIV are susceptible to a range of comorbidities.
Among these comorbidities is kidney disease, according to a new study that found among 6000 people living with HIV receiving care in 14 clinics in Washington, DC, there was an incident renal disease rate of 0.77 per 100 person-years, representing the 131 episodes observed throughout the study.
According to the researchers, the prevalence differs significantly from prior studies, but they noted that direct comparisons are difficult because of the lack of a standardization.
While other studies have examined the prevalence of kidney disease among people living with HIV, “These estimates were derived during an era when, compared with prior studies, early initiation of safer, more effective ART was recommended,” explained the researchers.
Tenofovir disoproxil fumarate (TDF), in particular, has been linked to an increased risk of acute kidney failure, leading the researchers to look at the 83% of patients participating in the study who had been prescribed TDF at some point throughout the study period.
The researchers found that recent exposure was not associated with kidney disease. They note that this is likely because providers have followed guidelines and avoided TDF in patients who are at risk of kidney disease or those with a glomerular filtration rate (GFR) of less than 600 ml/minute; GFR is a test used to assess how well the kidneys are working by estimating how much blood passes through the glomeruli every minute.
“Higher cumulative VL [viral load] was associated with renal disease; however, in a population in which most patients were virally suppressed, traditional risk factors, such as advanced age and lower baseline renal function, were also associated with renal disease” the authors wrote.
Every log increase in cumulative VL was associated with a 10% increased risk of kidney disease, suggesting that earlier time to viral suppression, typically a result of rapid initiation of ART, could result in lower kidney disease incidence. Patients who were older and had diabetes were also more likely to have an episode of kidney disease, as were patients who didn’t have private insurance.
Meanwhile, injection drug use and hepatitis C virus coinfection were marginally associated with kidney disease.
Doshi S, Ucanda M, Hart R, et al. Incidence and risk factors for renal disease in an outpatient cohort of HIV-infected patients on antiretroviral therapy. [Published online August 2019]. Kidney Int Rep. doi: 10.1016/j.ekir.2019.04.024.