The impact of hepatitis C virus coinfection on HIV-related kidney disease: a systematic review and meta-analysis

AIDS. 2008 Sep 12;22(14):1799-807. doi: 10.1097/QAD.0b013e32830e0152.


Background: In the era of antiretroviral therapy, non-AIDS complications such as kidney disease are important contributors to morbidity and mortality.

Objective: To estimate the impact of hepatitis C coinfection on the risk of kidney disease in HIV patients.

Design and methods: Two investigators identified English-language citations in MEDLINE and Web of Science from 1989 through 1 July 2007. References of selected articles were reviewed. Observational studies and clinical trials of HIV-related kidney disease and antiretroviral nephrotoxicity were eligible if they included at least 50 subjects and reported hepatitis C status. Data on study characteristics, population, and kidney disease outcomes were abstracted by two independent reviewers.

Results: After screening 2516 articles, 27 studies were eligible and 24 authors confirmed or provided data. Separate meta-analyses were performed for chronic kidney disease outcomes (n = 10), proteinuria (n = 4), acute renal failure (n = 2), and indinavir toxicity (n = 5). The pooled incidence of chronic kidney disease was higher in patients with hepatitis C coinfection [6.2 versus 4.0%; relative risk 1.49, 95% confidence interval (CI) 1.08-2.06]. In meta-regression, prevalence of black race and the proportion of patients with documented hepatitis C status were independently associated with the risk of chronic kidney disease. The relative risk associated with hepatitis C coinfection was significantly increased for proteinuria (1.15; 95% CI 1.02-1.30) and acute renal failure (1.64; 95% CI 1.21-2.23), with no significant statistical heterogeneity. The relative risk of indinavir toxicity was 1.59 (95% CI 0.99-2.54) with hepatitis C coinfection.

Conclusion: Hepatitis C coinfection is associated with a significant increase in the risk of HIV-related kidney disease.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Acute Kidney Injury / virology
  • African Continental Ancestry Group
  • HIV Infections / drug therapy
  • HIV Infections / ethnology
  • HIV Infections / virology*
  • HIV Protease Inhibitors / adverse effects
  • HIV Protease Inhibitors / therapeutic use
  • HIV-1*
  • Hepacivirus*
  • Hepatitis C / drug therapy
  • Hepatitis C / ethnology
  • Hepatitis C / virology*
  • Humans
  • Indinavir / adverse effects
  • Indinavir / therapeutic use
  • Kidney Failure, Chronic / virology*
  • Proteinuria / virology
  • Risk


  • HIV Protease Inhibitors
  • Indinavir