HIV/renal studies (CHIC)

1
HIV/renal studies (CHIC)

• Baseline renal function as predictor of HIV/renal
  disease progression
• Death, opportunistic infection
• Severe chronic kidney disease (stages 4-5)
• Changes in renal function
• Accelerated decline in renal function
• Chronic kidney disease progression
• HIV/renal transplantation
• HIV/Fanconi syndrome

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Does renal function at baseline predict mortality
or progression to stages 4/5 CKD?

• Median time from HIV diagnosis to baseline eGFR
  was 4 3, 9 months
• Median follow-up was 5.7 IQR 2.7, 9.1 years
• 1,837 (9.6) died 79 (0.41) progressed to stage
  4/5 CKD

Total N () 19,111 (100)
Male N () 15,09 4(79)
Ethnicity N () Black 4,640 (24)
White/Other 14, 471 (76)
Hepatitis B surface antigen positive N () 1,097 (6)
Hepatitis C antibody positive N () 1,333 (7)
CD4 at time of baseline eGFR (cells/mm3) Median (IQR) 352 (212, 520)
Viral load at time of baseline eGFR (copies/ml) Median (IQR) 1995 (50, 32154)
Baseline eGFR-MDRD ml/min/1.73m2 Median (IQR) 95 (83, 108)
Baseline eGFR-CKD-EPI ml/min/1.73m2 Median (IQR) 100 (87, 112)
On cART at time of baseline eGFR N () 12,034 (62)
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Time to death in HIV positive patients
stratified by baseline eGFR
(a) eGFR-MDRD
(b) eGFR-CKD-EPI
100
100
90
75-89
90
75-89
60-74
30-59
60-74
30-59
15-29
lt15
15-29
lt15
75
75
Cumulative Mortality
50
50
25
25
0
0
0
5
10
15
0
5
10
15
Years from entry to the cohort
Years from entry to the cohort
Hamzah et al, BHIVA 2010
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Adjusted mortality hazard ratios(95 CI)
stratified by baseline eGFR
MDRD MDRD CKD-EPI CKD-EPI
eGFR Adjusted1 HR (95CI) P Adjusted1 HR (95CI) P
90 1 1
60-89 0.93 (0.84, 1.02) 0.13 1.02 (0.92, 1.13) 0.75
30-59 1.98 (1.53, 2.56) lt0.001 2.24 (1.72, 2.94) lt0.001
15-29 5.31 (3.13, 9.01) lt0.001 5.25 (3.04, 9.08) lt0.001
lt15 6.69 (4.07, 11.00) lt0.001 6.90 (4.20, 11.33) lt0.001
1 Estimates were adjusted for gender, ethnicity,
age at entry to cohort, and AIDS, CD4 cell
count and cART at baseline
Hamzah et al, BHIVA 2010
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Factors associated with progression to stage 4/5
CKD
MDRD MDRD CKD-EPI CKD-EPI
eGFR Adjusted SHR (95CI) P Adjusted SHR (95CI) P
90 1 1
89-75 3.50 (0.98, 12.6) 0.05 2.17 (0.61, 7.73) 0.23
74-60 11.86 (3.16, 44.5) lt0.001 14.0 (4.55, 43.1) lt0.001
59-30 140.9 (42.4, 463.1) lt0.001 115.9 (42.1, 319.6) lt0.001
Ethnicity
Black 3.38 (1.58, 7.25) 0.002 2.52 (1.20, 5.28) 0.01
CD4 cell count (cells/mm3) (per 50 cell increase) 0.95 (0.87, 1.04) 0.27 0.95 (0.86, 1.03) 0.26
Estimates were adjusted for all the variables in
table SHR Sub-hazard ratios CIConfidence
intervals
Hamzah et al, BHIVA 2010
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HIV/renal studies (CHIC)

• Baseline renal function as predictor of HIV/renal
  disease progression
• Death, opportunistic infection
• Severe chronic kidney disease (stages 4-5)
• Changes in renal function
• Accelerated decline in renal function
• Chronic kidney disease progression
• HIV/renal transplantation
• HIV/Fanconi syndrome

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ATV/r vs. EFVMedian Change in Creatinine
Clearance
A5202 Overall As-Treated
Daar, E et al. 17th CROI 2010. Abstract 59LB
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Annual decline in eGFR
3
97
Campbell LJ et al, HIV Med 2009 10329-36.
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Incident CKD in EuroSIDA

• CKD defined as
• confirmed eGFR lt60 if baseline eGFR gt60
• gt25 decline if baseline eGFR lt60
• 21,482 PYFU
• median 3.7 years
• 225 (3.3) progressed
• to CKD
• Incidence 1.1 (0.9-1.2)
• per 100py

Mocroft et al. AIDS 2010
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HIV/renal studies (CHIC)

• Baseline renal function as predictor of HIV/renal
  disease progression
• Death, opportunistic infection
• Severe chronic kidney disease (stages 4-5)
• Changes in renal function
• Accelerated decline in renal function
• Chronic kidney disease progression
• HIV/renal transplantation
• HIV/Fanconi syndrome

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HIV-Associated Kidney Disease ESRF
AIDS 2009 23 2517-21
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Fanconi syndrome
Prevalence 1-2 of patients receiving
Tenofovir Bone pain Phosphate wasting Osteomalaci
a Almost exclusively when tenofovir is
co-administered with a (boosted) PI