KIDNEY DISEASE IN HIV-POSITIVE PATIENTS

INTRODUCTION

• HIV infection is associated with kidney disease :

• HIV-associated nephropathy(HIVAN)

• progressive kidney failure (associated with death in AIDS stage).

Objectives

• Assessing the symptoms of kidney disease in HIV-positive persons that undergo antiviral treatment , monitored in “Clinica Boli Infectioase I, Tg.Mures”, in 2010.

Methods

• Statistical Analysis ( GraphPad InStat 3)

• Retrospective study

• Random sample

• 40 patients

Methods

• Glomerular Filtration Rate(GFR)

• Proteinuria

• Urinalysis

• Kidney ecogarphy

The changes found where correlated with:

• HIV-infection exposure period

• immunodepression stage

• types of Antiretroviral (ARV) drugs

Chronic kidney disease :

• GFR <60 ml/min/1.73 sqr.m

• > 3 months

• using the Cockcroft-Gault formula (www.cphiv.dk/TOOLS/GFR/tabid/301/Default.aspx)

Results:• Average age: 22 years• Average age of HIV-infection exposure period: 15

years• exposure period to antiretroviral drugs: 9,5 years

Kidney disease was found in 65% of the patients and was associated with the following changes:

• decrease of the GFR• asymptomatic proteinuria• kidney lithiasis

Distribution of sample, depending on year of birth

198938%

198818%

199015%

other years30%

Distribution of sample, depending on stage of HIV infection

C3 stage40%

C2 stage38%

B1 stage10%

B2 stage13%

Decrease of the GFR

GFR = 60-709%

GFR >7041%

GFR > 10022%

GFR > 15028%

Asymptomatic proteinuria

C3 stage71%

C2 stage14%

B1 stage14%

17.5% of total

Kidney lithiasis

C3 stage50%

C2 stage25%

B2 stage8%

B1 stage17%

32.5 % from total

Kidney lithiasis is associated with :

• Ureterohydronephrosis (8%)

• Urinary tract infections (UTI) (37.5 %)

UTI associating CD4<200/cubic mm

Value of CD4 UTI -YES UTI -NO TOTAL

<200 9% 20% 29%

>200 22% 49% 71%

TOTAL 31% 69% 100%

UTI associating CD4<200 (Fisher’s test)

• p=1

• Relative risk = 0,93%

• Conffidence interval 95% = 0,31 - 2,83

Distribution of bacteria in UTI

E. Coli75%

Enterococcus spp.12%

Klebsiella spp12%

Antiretroviral therapy:

RTNI58%

RTNNI25%

PI17%

period of exposure= 9.5 yearsRTNI= Reversetranscriptaze Nucleosidic InhibitorsRTNNI=Reversetranscriptaze Non-Nucleozidic

Inhibitors

PI= Proteaze Inhibitors

Conclusions:• 65% of the patients presented one or more

changes of the kidney function:

• asymptomatic proteinuria (17,5%)

• kidney lithiasis (35,2%)

• UTI (32%)

Conclusions:

• There was no decrease of the GFR < 60 ml/min/1.73 sqr.m

• There was no association between CD4<200 and UTI

Conclusions:

• Although chronicaly exposed to HIV infection and antiretroviral drugs, the patients included in this study did not show HIV-associated nephropathy ( HIVAN) .

Bibliography:• http://www.cphiv.dk/TOOLS/GFR/tabid/301/Default.aspx -GFR Calculate • www.medscape.com/vewarticle/731174 -”Estimated GFR rate, Chronic• Kidney Disease and Antiretroviral Drug use in HIV-positive patients”(A Mocoft, O

Kirk, P Reiss, S De Wit, D Sedlacek, M Beniowski, J Gattell, A N Phillips, B Lendergerber, JD Lundgren)

• www.medscape.com/vewarticle/735313 -”Evaluation of GFR in HIV-1_infected Patients Before and After Combined Antiretroviral Therapy Exposure”( F Tordato, A Cozzi Lepri, P Cicconi, A De Luca, A, Antinori,V Colangeli, A Castagna, P Nasta, N Landisa, A Giacometti, A d”Arminio Monoforte)

• Campbell LJ, Ibrahim F, Fisher M, Holt SG, Hendry BM, Post FA. Spectrum of chronic kidney disease HIV-infected patients, HIV Med 2009;

• National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;

• Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. www.aidsinfo.nih.gov; 2010;

Thank You for your attention!