Hepatitis C co-infection is associated with an increased risk of incident chronic kidney disease in HIV-infected patients initiating combination antiretroviral therapy.

Abstract

BACKGROUND:

Combination antiretroviral therapy (cART) has reduced mortality from AIDS-related illnesses and chronic comorbidities have become prevalent among HIV-infected patients. We examined the association between hepatitis C virus (HCV) co-infection and chronic kidney disease (CKD) among patients initiating modern antiretroviral therapy.

METHODS:

Data were obtained from the Canadian HIV Observational Cohort for individuals initiating cART from 2000 to 2012. Incident CKD was defined as two consecutive serum creatinine-based estimated glomerular filtration (eGFR) measurements <60 mL/min/1.73m2 obtained ≥3 months apart. CKD incidence rates after cART initiation were compared between HCV co-infected and HIV mono-infected patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression.

RESULTS:

We included 2595 HIV-infected patients with eGFR >60 mL/min/1.73m2 at cART initiation, of which 19% were HCV co-infected. One hundred and fifty patients developed CKD during 10,903 person-years of follow-up (PYFU). The CKD incidence rate was higher among co-infected than HIV mono-infected patients (26.0 per 1000 PYFU vs. 10.7 per 1000 PYFU). After adjusting for demographics, virologic parameters and traditional CKD risk factors, HCV co-infection was associated with a significantly shorter time to incident CKD (HR 1.97; 95% CI: 1.33, 2.90). Additional factors associated with incident CKD were female sex, increasing age after 40 years, lower baseline eGFR below 100 mL/min/1.73m2, increasing HIV viral load and cumulative exposure to tenofovir and lopinavir.

CONCLUSIONS:

HCV co-infection was associated with an increased risk of incident CKD among HIV-infected patients initiating cART. HCV-HIV co-infected patients should be monitored for kidney disease and may benefit from available HCV treatments.

• Authors: Carmine Rossi, Janet Raboud, Sharon Walmsley, Curtis Cooper, Tony Antoniou, Ann N Burchell, Mark Hull, Jason Chia, Robert S Hogg, Erica E M Moodie, Marina B Klein, Canadian Observational Cohort (CANOC) Collaboration
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 17 Issue 1 Pg. 246 (04 04 2017) ISSN: 1471-2334 [Electronic] England
• PMID: 28376824 (Publication Type: Journal Article)

Topics

• Adult
• Canada
• Cohort Studies
• Coinfection
• Female
• Glomerular Filtration Rate
• HIV Infections (complications, epidemiology)
• Hepacivirus
• Hepatitis C (complications, epidemiology)
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Proportional Hazards Models
• Renal Insufficiency, Chronic (etiology)
• Risk Factors