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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predictors of renal outcome in HIV-associated nephropathy
Clinical Infectious Diseases, Volume 46, No. 8, Year 2008
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Description
Background. Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of end-stage renal disease among African American patients. This study was performed to study the epidemiology of HIVAN in a predominantly black African population and the impact of highly active antiretroviral therapy and other factors on the development of end-stage renal disease. Methods. We retrospectively identified all patients with HIVAN, defined by biopsy or strict clinical criteria, in 8 clinics in the United Kingdom. Baseline renal function, HIV parameters, renal pathological index of chronic damage, and responses to highly active antiretroviral therapy were analyzed, and factors associated with adverse renal outcome were identified. Results. From 1998 through 2004, we studied 16,834 patients, 61 of whom had HIVAN. HIVAN prevalence in black patients was 0.93%, and HIVAN incidence in those without renal disease at baseline was 0.61 per 1000 person-years. After a median of 4.2 years, 34 patients (56%) had developed end-stage renal disease. There were no significant differences in renal function and HIV parameters at baseline, time to initiation of highly active antiretroviral therapy, and rates of HIV RNA suppression between the 20 patients who developed end-stage renal disease >3 months after receiving the HIVAN diagnosis and the 23 patients who maintained stable renal function. However, the index of chronic damage score was significantly higher in those who developed end-stage renal disease (P < .001), and an index of chronic damage score >75 was associated with shorter renal survival (P < .001). Conclusions. Whereas overall patient survival suggested an important benefit of highly active antiretroviral therapy, no additional renal benefit of early initiation of highly active antiretroviral therapy or viral suppression could be demonstrated in this large cohort of patients with established HIVAN. Severity of chronic kidney damage, as quantified by biopsy, was the strongest predictor of renal outcome. © 2008 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Post, Frank A.
United Kingdom, London
King's College London
United Kingdom, London
Faculty of Life Sciences & Medicine
Campbell, Lucy J.
United Kingdom, London
King's College London
Fisher, Martin J.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Holt, S. G.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Bhagani, Sanjay R.
United Kingdom, London
The Royal Free Hospital
Wilkins, Edmund G.L.
United Kingdom, Manchester
North Manchester General Hospital
Ainsworth, Jonathan G.
United Kingdom, London
North Middlesex University Hospital
Macallan, Derek Clive
United Kingdom, London
St George's Hospital
Banerjee, Debasish
United Kingdom, London
St George's Hospital
Baily, Guy G.
United Kingdom, London
Barts and the London School of Medicine and Dentistry
Thuraisingham, Raj C.
United Kingdom, London
Barts and the London School of Medicine and Dentistry
Edwards, Simon G.
United Kingdom, London
University College London
Connolly, John O.
United Kingdom, London
The Royal Free Hospital
Easterbrook, Philippa Jane
United Kingdom, London
King's College London
Statistics
Citations: 72
Authors: 14
Affiliations: 12
Identifiers
Doi:
10.1086/529385
ISSN:
10584838
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study