The impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women

Michelle M. Estrella, Rulan S. Parekh, Alison Abraham, Brad C. Astor, Lynda A. Szczech, Kathryn Anastos, Jack A. Dehovitz, Daniel J. Merenstein, C. Leigh Pearce, Phyllis C. Tien, Mardge H. Cohen, Stephen J. Gange

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: In the early highly active antiretroviral therapy (HAART) era, kidney dysfunction was strongly associated with death among HIV-infected individuals. We re-examined this association in the later HAART period to determine whether chronic kidney disease remains a predictor of death after HAART initiation. Methods: To evaluate the effect of kidney function at the time of HAART initiation on time to all-cause mortality, we evaluated 1415 HIV-infected women initiating HAART in the Women's Interagency HIV Study. Multivariable proportional hazards models with survival times calculated from HAART initiation to death were constructed; participants were censored at the time of the last available visit or December 31, 2006. Results: Chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m) at HAART initiation was associated with higher mortality risk adjusting for age, race, hepatitis C serostatus, AIDS history, and CD4 cell count (hazard ratio 2.23, 95% confidence interval: 1.45-3.43). Adjustment for hypertension and diabetes history attenuated this association (hazard ratio = 1.89, confidence interval: 0.94-3.80). Lower kidney function at HAART initiation was weakly associated with increased mortality risk in women with prior AIDS (hazard ratio = 1.09, confidence interval: 1.00-1.19, per 20% decrease in estimated glomerular filtration rate). Conclusions: Kidney function at HAART initiation remains an independent predictor of death in HIV-infected individuals, especially in those with a history of AIDS. Our study emphasizes the necessity of monitoring kidney function in this population. Additional studies are needed to determine mechanisms underlying the increased mortality risk associated with chronic kidney disease in HIV-infected persons.

Original languageEnglish (US)
Pages (from-to)217-220
Number of pages4
JournalJournal of Acquired Immune Deficiency Syndromes
Volume55
Issue number2
DOIs
StatePublished - Oct 1 2010
Externally publishedYes

Fingerprint

Highly Active Antiretroviral Therapy
HIV
Kidney
Mortality
Chronic Renal Insufficiency
Acquired Immunodeficiency Syndrome
Confidence Intervals
Glomerular Filtration Rate
CD4 Lymphocyte Count
Hepatitis C
Secondary Prevention
Proportional Hazards Models
History
Hypertension
Survival

Keywords

  • Antiretroviral therapy
  • HIV
  • Kidney disease
  • Mortality
  • WIHS

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Medicine(all)

Cite this

The impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women. / Estrella, Michelle M.; Parekh, Rulan S.; Abraham, Alison; Astor, Brad C.; Szczech, Lynda A.; Anastos, Kathryn; Dehovitz, Jack A.; Merenstein, Daniel J.; Pearce, C. Leigh; Tien, Phyllis C.; Cohen, Mardge H.; Gange, Stephen J.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 55, No. 2, 01.10.2010, p. 217-220.

Research output: Contribution to journalArticle

Estrella, MM, Parekh, RS, Abraham, A, Astor, BC, Szczech, LA, Anastos, K, Dehovitz, JA, Merenstein, DJ, Pearce, CL, Tien, PC, Cohen, MH & Gange, SJ 2010, 'The impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women', Journal of Acquired Immune Deficiency Syndromes, vol. 55, no. 2, pp. 217-220. https://doi.org/10.1097/QAI.0b013e3181e674f4
Estrella, Michelle M. ; Parekh, Rulan S. ; Abraham, Alison ; Astor, Brad C. ; Szczech, Lynda A. ; Anastos, Kathryn ; Dehovitz, Jack A. ; Merenstein, Daniel J. ; Pearce, C. Leigh ; Tien, Phyllis C. ; Cohen, Mardge H. ; Gange, Stephen J. / The impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women. In: Journal of Acquired Immune Deficiency Syndromes. 2010 ; Vol. 55, No. 2. pp. 217-220.
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abstract = "Background: In the early highly active antiretroviral therapy (HAART) era, kidney dysfunction was strongly associated with death among HIV-infected individuals. We re-examined this association in the later HAART period to determine whether chronic kidney disease remains a predictor of death after HAART initiation. Methods: To evaluate the effect of kidney function at the time of HAART initiation on time to all-cause mortality, we evaluated 1415 HIV-infected women initiating HAART in the Women's Interagency HIV Study. Multivariable proportional hazards models with survival times calculated from HAART initiation to death were constructed; participants were censored at the time of the last available visit or December 31, 2006. Results: Chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m) at HAART initiation was associated with higher mortality risk adjusting for age, race, hepatitis C serostatus, AIDS history, and CD4 cell count (hazard ratio 2.23, 95{\%} confidence interval: 1.45-3.43). Adjustment for hypertension and diabetes history attenuated this association (hazard ratio = 1.89, confidence interval: 0.94-3.80). Lower kidney function at HAART initiation was weakly associated with increased mortality risk in women with prior AIDS (hazard ratio = 1.09, confidence interval: 1.00-1.19, per 20{\%} decrease in estimated glomerular filtration rate). Conclusions: Kidney function at HAART initiation remains an independent predictor of death in HIV-infected individuals, especially in those with a history of AIDS. Our study emphasizes the necessity of monitoring kidney function in this population. Additional studies are needed to determine mechanisms underlying the increased mortality risk associated with chronic kidney disease in HIV-infected persons.",
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AU - Szczech, Lynda A.

AU - Anastos, Kathryn

AU - Dehovitz, Jack A.

AU - Merenstein, Daniel J.

AU - Pearce, C. Leigh

AU - Tien, Phyllis C.

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