Higher Prevalence and Faster Progression of Chronic Kidney Disease in Human Immunodeficiency Virus-Infected Middle-Aged Individuals Compared With Human Immunodeficiency Virus-Uninfected Controls

J Infect Dis. 2017 Sep 15;216(6):622-631. doi: 10.1093/infdis/jix202.


Background: Human immunodeficiency virus (HIV)-infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute.

Methods: We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2), albuminuria (albumin/creatinine ratio ≥3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93μg/mmol and/or fractional phosphate excretion >20% with plasma phosphate <0.8 mmol/L) in 596 HIV-infected and 544 HIV-uninfected AGEhIV Cohort Study participants. We also assessed whether being HIV-infected on cART, with follow-up censored when cART regimen was modified, was associated with greater eGFR decline or worsening albuminuria (increase ≥10%/year with change in albuminuria category).

Results: Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0-4.4), albuminuria (aOR = 5.8; 95% CI = 3.7-9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9-10.2]). Among 377 HIV-infected and 479 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (-0.56; 95% CI = -0.87 to -0.24 mL/min/1.73m2/year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3-4.0).

Conclusions: In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus-infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.

Keywords: HIV infection; albuminuria; proximal renal tubular dysfunction; renal impairment; tenofovir disoproxil fumarate.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Albuminuria / complications*
  • Albuminuria / drug therapy
  • Anti-HIV Agents / therapeutic use
  • Case-Control Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Phosphates / blood
  • Prevalence
  • Prospective Studies
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / drug therapy
  • Risk Factors
  • Tenofovir / therapeutic use


  • Anti-HIV Agents
  • Phosphates
  • Tenofovir