HIV, Chronic Kidney Disease Comorbidity Increases Risk of Serious Clinical Events

Individuals with HIV who are diagnosed with chronic kidney disease (CKD) are more likely to develop a serious illness or die within a few years, according to a study published in AIDS.

Although CKD is an established potential complication of HIV, the study noted that relatively little is known regarding the rates of serious clinical events that occur due to CKD in these individuals, including the role of modifiable risk factors.

For the study, the researchers followed 2467 individuals with HIV for approximately 3 years or until the development of end-stage kidney disease or another serious illness. CKD was defined as confirmed eGFR of 60 ml/min per 1.73³ or below or a 25% decline in eGFR. The researchers used data from the ongoing D:A:D study.

During the 2.7 years of follow-up, 24.1% of individuals with CKD developed a serious clinical event (SCE) [incidence rate 68.9/1000 PYFU (95% confidence interval 63.4-74.4)] with 8.3% (6.9-9.0) estimated to experience any SCE at 1 year following diagnosis, according to the study. This proportion further increased to 29% after 5 years, with 1- and 5-year mortality rates estimated at 4% and 15%, respectively.

Overall, the most common SCE was death (12.7%), followed by non-AIDS-defining malignancies (NADMs) (5.8%), cardiovascular disease (CVD) (5.6%), other AIDS (5%), and end-stage renal disease (2.9%).

A high prevalence of modifiable risk factors was identified, with smoking consistently associated with all CKD-related SCEs. Additionally, diabetes predicted rates of CVD, NADM, and death, whereas dyslipidemia was only significantly associated with CVD, the study found. Poor HIV-status predicted other AIDS and death, eGFR less than 30 ml/min per 1.73 m² predicted CVD and death, and low body mass index predicted other AIDS and death.

When comparing outcomes between individuals with HIV with and without CKD, the results showed that those with CKD had higher rates of SCE, especially for death and end-stage renal disease.

The findings have significant clinical implications for individuals with HIV and CKD, according to the researchers.

“In an era where many HIV-positive persons require less monitoring because of efficient antiretroviral treatment, persons with CKD carry a high burden of SCE,” they concluded. “Severe potentially modifiable risk factors play a central role for CKD-related morbidity and mortality.

Reference

Lene R, Lundgren JD, Law M, et al. Serious clinical events in HIV-positive persons with chronic kidney disease. AIDS. 2019. Doi: 10.1097/QAD.0000000000002331.