Suppression of HIV-1 replication by antiretroviral therapy improves renal function in persons with low CD4 cell counts and chronic kidney disease.

TitleSuppression of HIV-1 replication by antiretroviral therapy improves renal function in persons with low CD4 cell counts and chronic kidney disease.
Publication TypeJournal Article
Year of Publication2008
AuthorsKalayjian RC, Franceschini N, Gupta SK, Szczech LA, Mupere E, Bosch RJ, Smurzynski M, Albert JM
JournalAIDS
Volume22
Issue4
Pagination481-7
Date Published2008 Feb 19
ISSN1473-5571
KeywordsAdult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Chronic Disease, Cohort Studies, Female, Glomerular Filtration Rate, HIV Infections, HIV-1, Humans, Kidney Diseases, Male, Middle Aged, Prospective Studies, Viremia, Virus Replication
Abstract

OBJECTIVE: To examine the association between changes in glomerular filtration rates (GFR) and antiretroviral therapy (ART)-mediated suppression of plasma HIV-1 viremia.

DESIGN: : Observational, prospective, multicenter cohort study.

INTERVENTION: ART regimens or treatment strategies in HIV-1-infected subjects were implemented through randomized clinical trials; 1776 ambulatory subjects from these trials also enrolled in this cohort study.

METHOD: The association between suppression of viremia and GFR changes from baseline was examined using the abbreviated Modification of Diet and Renal Disease equation in mixed effects linear models.

RESULTS: GFR improvement was associated with ART-mediated suppression of plasma viremia in subjects with both chronic kidney disease stage > or = 2 and low baseline CD4 cell counts (< 200 cells/microl). In this subset, viral suppression (by > 1.0 log10 copies/ml or to < 400 copies/ml) was associated with an average increase in GFR of 9.2 ml/min per 1.73 m(2) from baseline (95% confidence interval, 1.6-16.8; P = 0.02) over a median follow-up of 160 weeks. The magnitude of this association increased in subjects who had greater baseline impairment of renal function, and it did not depend on race or sex.

CONCLUSIONS: Viral suppression was associated with GFR improvements in those with both low CD4 cell counts and impaired baseline renal function, supporting an independent contribution of HIV-1 replication to chronic renal dysfunction in advanced HIV disease. GFR improvement not associated with viral suppression also was observed in subjects with higher CD4 cell counts.

DOI10.1097/QAD.0b013e3282f4706d
Alternate JournalAIDS
PubMed ID18301060
PubMed Central IDPMC3529361
Grant ListAI25879 / AI / NIAID NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
K23 HL073682 / HL / NHLBI NIH HHS / United States
K23HL073682 / HL / NHLBI NIH HHS / United States
U01 AI025879 / AI / NIAID NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 AI038858 / AI / NIAID NIH HHS / United States