Kidney diseases in HIV/HCV-co-infected patients

AIDS. 2009 Jun 19;23(10):1219-26. doi: 10.1097/QAD.0b013e32832ac36a.

Abstract

Background: Hepatitis C virus (HCV) co-infection occurs in 25% of HIV-infected persons. The impact of HIV/HCV coinfection on renal and patient outcomes is unclear.

Methods: The main objective of the study is the comparison of outcomes (progression to advanced renal failure, initiation of dialysis, and death) in patients with HIV (n = 40), HCV (n = 30) or coinfection (n = 30) during the period between January 1999 and December 2007.

Results: Patients were predominantly white men with a mean creatinine clearance of 50.6 +/- 32.2 ml per min per 1.73 m. Membranoproliferative glomerulonephritis (MPGN) and HIV-associated nephropathy were found in 34 and 9%, respectively. Seventeen patients needed transitory or definitive hemodialysis after 2, 2.5, and 12 months in HIV/HCV (n = 5), HIV (n = 6) and HCV (n = 6) infections, respectively. In multivariate analysis, variables found to independently predict outcome in HIV/HCV coinfected patients were younger age, a longer delay to kidney biopsy, cryoglobulinemia and MPGN. Twenty-one patients died, mostly in the HCV (n = 8) and/or HIV/HCV coinfected (n = 12) groups. The relative risk of death for HIV/HCV co-infected patients was 2.1 times more than for HCV-infected patients and 7.5 times more than for HIV-infected patients. HIV/HCV co-infection [odds ratio (OR), = 4; 95% confidence interval (CI), 1.3-12.9; P = 0.015] and MPGN (OR, 6; 95% CI, 2-18.8; P = 0.0018) were independently associated with death.

Conclusion: Kidney disease is a relatively frequent complication in HIV or HCV monoinfected individuals. The impact of kidney disease on survival of HIV/HCV coinfected patients seems deleterious but remains largely unknown.

MeSH terms

  • AIDS-Associated Nephropathy / complications
  • Adult
  • Age Factors
  • Aged
  • Disease Progression
  • Epidemiologic Methods
  • Female
  • Glomerulonephritis, Membranoproliferative / virology
  • HIV Infections / complications*
  • Hepatitis C, Chronic / complications*
  • Humans
  • Kidney Diseases / virology*
  • Male
  • Middle Aged
  • Prognosis
  • Renal Dialysis
  • Renal Insufficiency / virology