The effects of HIV type-1 viral suppression and non-viral factors on quantitative proteinuria in the highly active antiretroviral therapy era.

TitleThe effects of HIV type-1 viral suppression and non-viral factors on quantitative proteinuria in the highly active antiretroviral therapy era.
Publication TypeJournal Article
Year of Publication2009
AuthorsGupta SK, Smurzynski M, Franceschini N, Bosch RJ, Szczech LA, Kalayjian RC
Corporate AuthorsAIDS Clinical Trials Group Longitudinal Linked Randomized Trials Study Team
JournalAntivir Ther
Volume14
Issue4
Pagination543-9
Date Published2009
ISSN1359-6535
KeywordsAdult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Female, HIV Infections, HIV-1, Humans, Longitudinal Studies, Male, Middle Aged, Prevalence, Proteinuria
Abstract

BACKGROUND: Proteinuria is associated with progressive renal disease and overall mortality in HIV-infected patients; however, the prevalence and correlates of quantitative proteinuria in the highly active antiretroviral therapy era are unknown.

METHODS: Spot urine protein to creatinine (P/Cr) ratios, an accepted measure of quantitative daily proteinuria, were measured annually since 2002 in participants of the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. We used linear regression models with general estimating equations to identify factors associated with the abnormal P/Cr thresholds of >/=0.2 and >/=1.0.

RESULTS: Of the 2,857 participants (most of whom were receiving antiretroviral therapy) analysed, 16% and 3% had P/Cr levels >/=0.2 and >/=1.0, respectively, at first measurement. P/Cr levels did not change during a median follow-up of 3 years (interquartile range 2-4). Factors associated with P/Cr>/=0.2 at any measurement included greater age, lower glomerular filtration rate, female sex, antiretroviral therapy prior to entry into parent randomized trial, HIV type-1 RNA level >/=400 copies/ml, lower CD4(+) T-cell count and history of hypertension, diabetes or hepatitis C coinfection (all P<0.04). Black race and higher non-high-density lipoprotein cholesterol levels were associated with P/Cr levels >/=1.0, but not with P/Cr levels >/=0.2. Hepatitis B coinfection and current use of adefovir, indinavir and tenofovir were not associated with either of the P/Cr thresholds.

CONCLUSIONS: Both HIV-1 and non-HIV-1-related factors are associated with abnormal levels of proteinuria and identify those who are at a greater risk of worse clinical outcomes. Several of these factors are differentially associated with lower and higher proteinuria thresholds.

Alternate JournalAntivir. Ther. (Lond.)
PubMed ID19578239
PubMed Central IDPMC2720522
Grant ListAHA0675001N / / PHS HHS / United States
AI069484 / AI / NIAID NIH HHS / United States
AI25859 / AI / NIAID NIH HHS / United States
AI25879 / AI / NIAID NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
AI68634 / AI / NIAID NIH HHS / United States
AI68636 / AI / NIAID NIH HHS / United States
K23 HL073682 / HL / NHLBI NIH HHS / United States
R01 DK068336 / DK / NIDDK NIH HHS / United States
R01 HL089651 / HL / NHLBI NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068634-03 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI068636-01 / AI / NIAID NIH HHS / United States