Cystatin C and baseline renal function among HIV-infected persons in the SUN Study.

Abstract

In the combination antiretroviral therapy (cART) era, renal dysfunction remains common. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) (ClinicalTrials.gov number, NCT00146419) is a prospective observational cohort study of HIV-infected adults. At baseline, comprehensive data were collected, including cystatin C and measures of renal function. Univariate and multivariate regression analyses were performed to identify factors associated with baseline renal dysfunction [estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m(2) calculated using the simplified Modification of Diet in Renal Disease equation] and elevated cystatin C (>1.0 mg/liter) in a cross-sectional analysis. Among 670 subjects with complete data (mean age 41 years, mean CD4 cell count 530 cells/mm(3), 79% prescribed cART), the mean eGFR was 96.8 ml/min/1.73 m(2). Forty percent of subjects had renal dysfunction; 3.3% had chronic kidney disease (eGFR < 60 ml/min/1.73 m(2)). Elevated cystatin C was present in 18% of subjects. In multivariate analysis, renal dysfunction was associated with older age, non-Hispanic white race/ethnicity, higher body mass index (BMI), hypertension, higher cystatin C levels, and current prescription of ritonavir. Factors associated with elevated cystatin C included hepatitis C coinfection, hypertension, current smoking, older age, current tenofovir use, detectable plasma HIV RNA, and elevated microalbuminuria. The prevalence of chronic kidney disease (CKD) was low in this contemporary HIV cohort. However, mild to moderate renal dysfunction was common despite the widespread use of cART.

• Authors: Edgar Turner Overton, Pragna Patel, Kristin Mondy, Tim Bush, Lois Conley, Frank Rhame, Erna Milunka Kojic, John Hammer, Keith Henry, John T Brooks, Sun Study Investigators
• Journal: AIDS research and human retroviruses (AIDS Res Hum Retroviruses) Vol. 28 Issue 2 Pg. 148-55 (Feb 2012) ISSN: 1931-8405 [Electronic] United States
• PMID: 21480819 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anti-HIV Agents
• Cystatin C
• Organophosphonates
• Tenofovir
• Adenine
• Ritonavir

Topics

• Adenine (analogs & derivatives, therapeutic use)
• Adult
• Anti-HIV Agents (adverse effects, therapeutic use)
• Body Mass Index
• CD4 Lymphocyte Count
• Cohort Studies
• Cross-Sectional Studies
• Cystatin C (drug effects, metabolism)
• Female
• Glomerular Filtration Rate
• HIV Seropositivity (drug therapy, epidemiology, metabolism)
• Hepatitis C (drug therapy, epidemiology, metabolism)
• Humans
• Hypertension (epidemiology)
• Male
• Organophosphonates (therapeutic use)
• Prospective Studies
• Renal Insufficiency (drug therapy, epidemiology, metabolism)
• Ritonavir (adverse effects, therapeutic use)
• Tenofovir