Palella FJ, et al. - Researchers sought to better characterize the factors affecting kidney function and proteinuria among HIV-positive (HIV+) and HIV-negative (HIV–) persons. A Decline in longitudinal kidney function was noted in association with HAART use but not with individual antiretroviral drug, and traditional kidney disease risks. HAART-treated men showed proteinuria nearly seven times more commonly than HIV- men, reflecting recent eGFR decline and predicting subsequent eGFR decline.

Methods

• HIV+ and HIV- men were evaluated for estimated glomerular filtration rate (eGFR, ml/min per 1.73 m²) changes, proteinuria prevalence (a urine protein-to-creatinine ratio of -0.2 at two consecutive visits) and associated factors.

Results

• Researchers recognized 917 HIV+ men receiving HAART, 159 HIV+ men not receiving HAART, and 1305 HIV- men from October 2003 to September 2014.
• Median annual eGFR change of -0.5 was noted; -0.8% for HIV+ and -0.3% for HIV- men (P < 0.001).
• HAART receipt (but no specific antiretroviral drug), age more than 50, hypertension, diabetes, current smoking were the factors significantly (P < 0.05) associated with more than 3% annual eGFR decline.
• They noted proteinuria in 14.9% of visit-pairs among HAART recipients, 5.8% among non-HAART recipients, and 1.9% among HIV- men; proteinuria was noted to be associated with subsequent annual more than 3% eGFR decline (odds ratio 1.80, P < 0.001).
• The following were also identified as proteinuria-associated factors: HAART use (vs HIV-), age at least 50 (vs <40), diabetes, hypertension, current smoking, hepatitis C virus-infection (all P < 0.05); and for HIV+ men, lower CD4+ cell count, didanosine, saquinavir, or nelfinavir use(all P < 0.05).
• Having a detectable HIV RNA, cumulative use of tenofovir disoproxil fumarate, emtricitabine, ritonavir, atazanavir, any protease inhibitor, or fluconazole were noted to be correlated with more than 3% annual eGFR decline among HAART users after adjusting for proteinuria.