TY - JOUR
T1 - HIV therapy, metabolic and cardiovascular health are associated with glomerular hyperfiltration among men with and without HIV infection
AU - Ng, Derek K.
AU - Jacobson, Lisa P.
AU - Brown, Todd T.
AU - Palella, Frank J.
AU - Martinson, Jeremy J.
AU - Bolan, Robert
AU - Miller, Edgar R.
AU - Schwartz, George J.
AU - Abraham, Alison G.
AU - Estrella, Michelle M.
PY - 2014/1/28
Y1 - 2014/1/28
N2 - Objective: Diabetes and hypertension, common conditions in antiretroviral-treated HIV-infected individuals, are associated with glomerular hyperfiltration, which precedes the onset of proteinuria and accelerated kidney function decline. In the Multicenter AIDS Cohort Study, we examined the extent to which hyperfiltration is present and associated with metabolic, cardiovascular, HIV and treatment risk factors among HIV-infected men. Design: Cross-sectional cohort using direct measurement of glomerular filtration rate by iohexol plasma clearance for 367 HIV-infected men and 241 HIV-uninfected men who were free of chronic kidney disease. Methods: Hyperfiltration was defined as glomerular filtration rate above 140-1 ml/min per 1.73 m2 per year over age 40. Multivariate logistic regression was used to estimate the odds ratios (ORs) of prevalent hyperfiltration for metabolic, cardiovascular, HIV and cumulative antiretroviral exposure factors. Results: Among individuals without chronic kidney disease, the prevalence of hyperfiltration was higher for HIV-infected participants (25%) compared to uninfected participants (17%; P=0.01). After adjustment, HIV infection remained associated with hyperfiltration [OR 1.70, 95% confidence interval (CI) 1.11-2.61] and modified the association between diabetes and hyperfiltration, such that the association among HIVuninfected men (OR 2.56, 95% CI 1.33-5.54) was not observed among HIV-infected men (OR 1.19, 95% CI 0.69-2.05). These associations were independent of known risk factors for hyperfiltration. Indicators of hyperglycemia and hypertension were also associated with hyperfiltration as was cumulative zidovudine exposure. Conclusion: Hyperfiltration, a potential modifiable predictor of kidney disease progression, is significantly higher among antiretroviral-treated HIV-infected men. Furthermore, HIV-infection nullifies the association of diabetes and hyperfiltration present in HIV-uninfected men.
AB - Objective: Diabetes and hypertension, common conditions in antiretroviral-treated HIV-infected individuals, are associated with glomerular hyperfiltration, which precedes the onset of proteinuria and accelerated kidney function decline. In the Multicenter AIDS Cohort Study, we examined the extent to which hyperfiltration is present and associated with metabolic, cardiovascular, HIV and treatment risk factors among HIV-infected men. Design: Cross-sectional cohort using direct measurement of glomerular filtration rate by iohexol plasma clearance for 367 HIV-infected men and 241 HIV-uninfected men who were free of chronic kidney disease. Methods: Hyperfiltration was defined as glomerular filtration rate above 140-1 ml/min per 1.73 m2 per year over age 40. Multivariate logistic regression was used to estimate the odds ratios (ORs) of prevalent hyperfiltration for metabolic, cardiovascular, HIV and cumulative antiretroviral exposure factors. Results: Among individuals without chronic kidney disease, the prevalence of hyperfiltration was higher for HIV-infected participants (25%) compared to uninfected participants (17%; P=0.01). After adjustment, HIV infection remained associated with hyperfiltration [OR 1.70, 95% confidence interval (CI) 1.11-2.61] and modified the association between diabetes and hyperfiltration, such that the association among HIVuninfected men (OR 2.56, 95% CI 1.33-5.54) was not observed among HIV-infected men (OR 1.19, 95% CI 0.69-2.05). These associations were independent of known risk factors for hyperfiltration. Indicators of hyperglycemia and hypertension were also associated with hyperfiltration as was cumulative zidovudine exposure. Conclusion: Hyperfiltration, a potential modifiable predictor of kidney disease progression, is significantly higher among antiretroviral-treated HIV-infected men. Furthermore, HIV-infection nullifies the association of diabetes and hyperfiltration present in HIV-uninfected men.
KW - Antiretroviral therapy
KW - Glomerular filtration rate
KW - Glomerular hyperfiltration
KW - HIV
KW - Iohexol
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UR - http://www.scopus.com/inward/citedby.url?scp=84894073434&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000000094
DO - 10.1097/QAD.0000000000000094
M3 - Article
C2 - 24670523
AN - SCOPUS:84894073434
SN - 0269-9370
VL - 28
SP - 377
EP - 386
JO - AIDS
JF - AIDS
IS - 3
ER -
