Kidney disease in antiretroviral-naïve HIV-positive adults with high CD4 counts

Prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) START Study Group

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives: HIV infection has been associated with an increased risk of chronic kidney disease (CKD). Little is known about the prevalence of CKD in individuals with high CD4 cell counts prior to initiation of antiretroviral therapy (ART). We sought to address this knowledge gap. Methods: We describe the prevalence of CKD among 4637 ART-naïve adults (mean age 36.8 years) with CD4 cell counts >500 cells/μL at enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. CKD was defined by estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 and/or dipstick urine protein ≥1+. Logistic regression was used to identify baseline characteristics associated with CKD. Results: Among 286 [6.2%; 95% confidence interval (CI) 5.5%, 6.9%] participants with CKD, the majority had isolated proteinuria. A total of 268 participants had urine protein ≥1+, including 41 with urine protein ≥2+. Only 22 participants (0.5%) had an estimated glomerular filtration rate <60mL/min/1.73m2, including four who also had proteinuria. Baseline characteristics independently associated with CKD included diabetes [adjusted odds ratio (aOR) 1.73; 95% CI 1.05, 2.85], hypertension (aOR 1.82; 95% CI 1.38, 2.38), and race/ethnicity (aOR 0.59; 95% CI 0.37, 0.93 for Hispanic vs. white). Conclusions: We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-naïve clinical trial participants with CD4 cell counts >500 cells/μL.

Original languageEnglish (US)
Pages (from-to)55-63
Number of pages9
JournalHIV Medicine
Volume16
Issue numberS1
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

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Kidney Diseases
CD4 Lymphocyte Count
Chronic Renal Insufficiency
HIV
Glomerular Filtration Rate
HIV Infections
Therapeutics

Keywords

  • Antiretroviral therapy
  • Kidney disease
  • Strategic timing of antiretroviral treatment (START) trial

ASJC Scopus subject areas

  • Health Policy
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Kidney disease in antiretroviral-naïve HIV-positive adults with high CD4 counts : Prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. / International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) START Study Group.

In: HIV Medicine, Vol. 16, No. S1, 01.04.2015, p. 55-63.

Research output: Contribution to journalArticle

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title = "Kidney disease in antiretroviral-na{\"i}ve HIV-positive adults with high CD4 counts: Prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial",
abstract = "Objectives: HIV infection has been associated with an increased risk of chronic kidney disease (CKD). Little is known about the prevalence of CKD in individuals with high CD4 cell counts prior to initiation of antiretroviral therapy (ART). We sought to address this knowledge gap. Methods: We describe the prevalence of CKD among 4637 ART-na{\"i}ve adults (mean age 36.8 years) with CD4 cell counts >500 cells/μL at enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. CKD was defined by estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 and/or dipstick urine protein ≥1+. Logistic regression was used to identify baseline characteristics associated with CKD. Results: Among 286 [6.2{\%}; 95{\%} confidence interval (CI) 5.5{\%}, 6.9{\%}] participants with CKD, the majority had isolated proteinuria. A total of 268 participants had urine protein ≥1+, including 41 with urine protein ≥2+. Only 22 participants (0.5{\%}) had an estimated glomerular filtration rate <60mL/min/1.73m2, including four who also had proteinuria. Baseline characteristics independently associated with CKD included diabetes [adjusted odds ratio (aOR) 1.73; 95{\%} CI 1.05, 2.85], hypertension (aOR 1.82; 95{\%} CI 1.38, 2.38), and race/ethnicity (aOR 0.59; 95{\%} CI 0.37, 0.93 for Hispanic vs. white). Conclusions: We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-na{\"i}ve clinical trial participants with CD4 cell counts >500 cells/μL.",
keywords = "Antiretroviral therapy, Kidney disease, Strategic timing of antiretroviral treatment (START) trial",
author = "{International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) START Study Group} and Ac Achhra and A. Mocroft and Ross, {Michael J.} and L. Ryom and Gm Lucas and H. Furrer and J. Neuhaus and C. Somboonwit and M. Kelly and Jm Gatell and Cm Wyatt",
year = "2015",
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T1 - Kidney disease in antiretroviral-naïve HIV-positive adults with high CD4 counts

T2 - Prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

AU - International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) START Study Group

AU - Achhra, Ac

AU - Mocroft, A.

AU - Ross, Michael J.

AU - Ryom, L.

AU - Lucas, Gm

AU - Furrer, H.

AU - Neuhaus, J.

AU - Somboonwit, C.

AU - Kelly, M.

AU - Gatell, Jm

AU - Wyatt, Cm

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N2 - Objectives: HIV infection has been associated with an increased risk of chronic kidney disease (CKD). Little is known about the prevalence of CKD in individuals with high CD4 cell counts prior to initiation of antiretroviral therapy (ART). We sought to address this knowledge gap. Methods: We describe the prevalence of CKD among 4637 ART-naïve adults (mean age 36.8 years) with CD4 cell counts >500 cells/μL at enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. CKD was defined by estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 and/or dipstick urine protein ≥1+. Logistic regression was used to identify baseline characteristics associated with CKD. Results: Among 286 [6.2%; 95% confidence interval (CI) 5.5%, 6.9%] participants with CKD, the majority had isolated proteinuria. A total of 268 participants had urine protein ≥1+, including 41 with urine protein ≥2+. Only 22 participants (0.5%) had an estimated glomerular filtration rate <60mL/min/1.73m2, including four who also had proteinuria. Baseline characteristics independently associated with CKD included diabetes [adjusted odds ratio (aOR) 1.73; 95% CI 1.05, 2.85], hypertension (aOR 1.82; 95% CI 1.38, 2.38), and race/ethnicity (aOR 0.59; 95% CI 0.37, 0.93 for Hispanic vs. white). Conclusions: We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-naïve clinical trial participants with CD4 cell counts >500 cells/μL.

AB - Objectives: HIV infection has been associated with an increased risk of chronic kidney disease (CKD). Little is known about the prevalence of CKD in individuals with high CD4 cell counts prior to initiation of antiretroviral therapy (ART). We sought to address this knowledge gap. Methods: We describe the prevalence of CKD among 4637 ART-naïve adults (mean age 36.8 years) with CD4 cell counts >500 cells/μL at enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. CKD was defined by estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 and/or dipstick urine protein ≥1+. Logistic regression was used to identify baseline characteristics associated with CKD. Results: Among 286 [6.2%; 95% confidence interval (CI) 5.5%, 6.9%] participants with CKD, the majority had isolated proteinuria. A total of 268 participants had urine protein ≥1+, including 41 with urine protein ≥2+. Only 22 participants (0.5%) had an estimated glomerular filtration rate <60mL/min/1.73m2, including four who also had proteinuria. Baseline characteristics independently associated with CKD included diabetes [adjusted odds ratio (aOR) 1.73; 95% CI 1.05, 2.85], hypertension (aOR 1.82; 95% CI 1.38, 2.38), and race/ethnicity (aOR 0.59; 95% CI 0.37, 0.93 for Hispanic vs. white). Conclusions: We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-naïve clinical trial participants with CD4 cell counts >500 cells/μL.

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KW - Kidney disease

KW - Strategic timing of antiretroviral treatment (START) trial

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