HIV viremia and changes in kidney function

Objective: To evaluate the effect of HIV infection on longitudinal changes in kidney function and to identify independent predictors of kidney function changes in HIV-infected individuals. Design: A prospective cohort. Methods: Cystatin C was measured at baseline and at the 5-year follow-up visit of the Study of Fat Redistribution and Metabolic Change in HIV infection in 554 HIV-infected participants and 230 controls. Control participants were obtained from the Coronary Artery Risk Development in Young Adults Study. Glomerular filtration rate (eGFR(cys)) was estimated using the formula 76.7 x cysC(-1.19). Results: Compared with controls, HIV-infected participants had a greater proportion of clinical decliners (annual decrease in eGFR(cys) > 3 ml/min per 1.73 m(2); 18 versus 13%, P=0.002) and clinical improvers (annual increase in eGFR(cys) > 3 ml/min per 1.73 m(2); 26 versus 6%, P<0.0001). After multivariable adjustment, HIV infection was associated with higher odds of both clinical decline (odds ratio 2.2; 95% confidence interval 1.3, 3.9, P=0.004) and clinical improvement (odds ratio 7.3; 95% confidence interval 3.9, 13.6, P <= 0.0001). Among HIV-infected participants, a decrease in HIV viral load during follow-up was independently associated with clinical improvement; conversely, higher baseline and an increase in viral load during follow-up were associated with clinical decline. No individual antiretroviral drug or drug class appeared to be substantially associated with clinical decline or improvement. Conclusion: Compared with controls, HIV-infected persons were more likely both to have clinical decline and clinical improvement in kidney function during 5 years of follow-up. The extent of viremic control had a strong association with longitudinal changes in kidney function. (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins