TY - JOUR
T1 - Hepatitis C Seropositivity and Kidney Function Decline Among Women With HIV
T2 - Data From the Women's Interagency HIV Study
AU - Tsui, Judith
AU - Vittinghoff, Eric
AU - Anastos, Kathryn
AU - Augenbraun, Michael
AU - Young, Mary
AU - Nowicki, Marek
AU - Cohen, Mardge H.
AU - Peters, Marion G.
AU - Golub, Elizabeth T.
AU - Szczech, Lynda
N1 - Funding Information:
Support: WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-A1-34989, UO1-AI-34993, and UO1-AI-42590) and the National Institute of Child Health and Human Development (UO1-HD-32632). The study is cofunded by the National Cancer Institute, National Institute on Drug Abuse, and National Institute on Deafness and Other Communication Disorders. Funding also is provided by the National Center for Research Resources through Clinical and Translational Science Award UL RR024131 to the UCSF Clinical and Translational Science Institute and Grant KL2RR024130 to Dr Tsui.
PY - 2009/7
Y1 - 2009/7
N2 - Background: How coinfection with hepatitis C virus (HCV) impacts on the trajectory of kidney function in human immunodeficiency virus (HIV)-infected patients is unclear. This study examined the effect of HCV infection on kidney function over time in women infected with HIV. Study Design: Retrospective observational cohort. Setting & Participants: Study sample included participants from the Women's Interagency HIV Study who were HIV infected and had undergone HCV antibody testing and serum creatinine measurement at baseline. Predictor: HCV seropositivity. Outcomes & Measurement: Estimated glomerular filtration rate (eGFR) calculated from semi-annual serum creatinine measurements using the 4-variable Modification of Diet in Renal Diseases (MDRD) Study equation. Linear mixed models were used to evaluate the independent effect of HCV seropositivity on eGFR over time, adjusting for demographic factors, comorbid conditions, illicit drug use, measures of HIV disease status, use of medications, and interactions with baseline low eGFR (<60 mL/min/1.73 m2). Results: Of 2,684 HIV-infected women, 952 (35%) were found to be HCV seropositive. In 180 women with chronic kidney disease (CKD) at baseline (eGFR < 60 mL/min/1.73 m2), HCV seropositivity was independently associated with a fully adjusted net decrease in eGFR of approximately 5% per year (95% confidence interval, 3.2 to 7.2) relative to women who were seronegative. In contrast, HCV infection was not independently associated with a decrease in eGFR in women without low eGFR at baseline (P < 0.001 for interaction). Limitations: The MDRD Study equation has not been validated as a measure of GFR in persons with HIV or HCV infection. Proteinuria was not included in the study analysis. Because the study is observational, effects of residual confounding cannot be excluded. Conclusions: In HIV-infected women with CKD, coinfection with HCV is associated with a modest, but statistically significant, decrease in eGFR over time. More careful monitoring of kidney function may be warranted for HIV-infected patients with CKD who are also coinfected with HCV.
AB - Background: How coinfection with hepatitis C virus (HCV) impacts on the trajectory of kidney function in human immunodeficiency virus (HIV)-infected patients is unclear. This study examined the effect of HCV infection on kidney function over time in women infected with HIV. Study Design: Retrospective observational cohort. Setting & Participants: Study sample included participants from the Women's Interagency HIV Study who were HIV infected and had undergone HCV antibody testing and serum creatinine measurement at baseline. Predictor: HCV seropositivity. Outcomes & Measurement: Estimated glomerular filtration rate (eGFR) calculated from semi-annual serum creatinine measurements using the 4-variable Modification of Diet in Renal Diseases (MDRD) Study equation. Linear mixed models were used to evaluate the independent effect of HCV seropositivity on eGFR over time, adjusting for demographic factors, comorbid conditions, illicit drug use, measures of HIV disease status, use of medications, and interactions with baseline low eGFR (<60 mL/min/1.73 m2). Results: Of 2,684 HIV-infected women, 952 (35%) were found to be HCV seropositive. In 180 women with chronic kidney disease (CKD) at baseline (eGFR < 60 mL/min/1.73 m2), HCV seropositivity was independently associated with a fully adjusted net decrease in eGFR of approximately 5% per year (95% confidence interval, 3.2 to 7.2) relative to women who were seronegative. In contrast, HCV infection was not independently associated with a decrease in eGFR in women without low eGFR at baseline (P < 0.001 for interaction). Limitations: The MDRD Study equation has not been validated as a measure of GFR in persons with HIV or HCV infection. Proteinuria was not included in the study analysis. Because the study is observational, effects of residual confounding cannot be excluded. Conclusions: In HIV-infected women with CKD, coinfection with HCV is associated with a modest, but statistically significant, decrease in eGFR over time. More careful monitoring of kidney function may be warranted for HIV-infected patients with CKD who are also coinfected with HCV.
KW - Hepatitis C virus
KW - human immunodeficiency virus (HIV)
KW - kidney diseases
KW - women
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UR - http://www.scopus.com/inward/citedby.url?scp=67449132115&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2009.02.009
DO - 10.1053/j.ajkd.2009.02.009
M3 - Article
C2 - 19394735
AN - SCOPUS:67449132115
SN - 0272-6386
VL - 54
SP - 43
EP - 50
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -
