TY - JOUR
T1 - Association of HIV suppression with kidney disease progression among HIV-positive African Americans with biopsy-proven classic FSGS
AU - McMahon, Blaithin A.
AU - Hanouneh, Mohamad
AU - Chedid, Alice
AU - Fine, Derek M.
AU - Chen, Teresa K.
AU - Foy, Matthew
AU - Lucas, Gregory M.
AU - Estrella, Michelle M.
AU - Atta, Mohamed G.
N1 - Funding Information:
Received for publication June 8, 2018; accepted August 29, 2018. From the *Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD; †Division of Nephrology, Medical University of South Carolina, Charleston, SC; ‡Department of Internal Medicine in Baton Rouge, Louisiana State University Medical Center, New Orleans, LA; §Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD; and ║Division of Nephrology, University of California, San Francisco, CA. Supported by the NIDDK Grant K23DK081317. The authors have no funding or conflicts of interest to disclose. M.M.E. and M.G.A. are co-senior authors. Correspondence to: Mohamad Hanouneh, MD, Division of Nephrology, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, Room 416, Baltimore, MD 21287 (e-mail: Mhanoun1@jhmi.edu). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Background: In the era of combined antiretroviral therapy, classic focal segmental glomerulosclerosis (FSGS) is the most common histopathological finding in African American HIV-positive patients with kidney disease. We sought to determine whether HIV suppression is associated with lower risk of progression to end-stage renal disease (ESRD) among HIV-positive African Americans with biopsy-confirmed classic FSGS. Methods: HIV-positive African Americans who underwent kidney biopsies at a single tertiary hospital between January 1996 and June 2011 were confirmed as having classic FSGS by the presence of segmental glomerulosclerosis without features of HIV-associated nephropathy. Multivariable Cox proportional hazards models were used to examine the independent association of viral suppression (HIV-RNA, 400 copies per milliliter at biopsy) with time to progression to ESRD. Results: Of the 55 HIV-positive African Americans with classic FSGS, 26 had suppressed viral loads at the time of biopsy. Compared to viremic patients, those who were virally suppressed had a significantly higher mean CD4+ cell count (452 vs. 260 cell/mm3, respectively; P = 0.02) and median estimated glomerular filtration rate (53.5 vs 35.5 mL/min/ 1.73 m2, respectively; P = 0.002). Adjusting for sex and baseline CD4+ cell count, estimated glomerular filtration rate, and proteinuria, those with HIV-RNA levels,400 copies per milliliter at baseline had a 75% lower risk of progressing to ESRD (hazard ratio = 0.25; 95% CI: 0.07 to 0.88) during a median follow-up time of 2.70 years (interquartile range: 0.80-5.15 years). Conclusions: HIV suppression is associated with significantly lower risk of progression to ESRD among HIV-infected African Americans with classic FSGS, supporting the potential role of combined antiretroviral therapy for this histopathology in addition to HIV-associated nephropathy among HIV-positive individuals.
AB - Background: In the era of combined antiretroviral therapy, classic focal segmental glomerulosclerosis (FSGS) is the most common histopathological finding in African American HIV-positive patients with kidney disease. We sought to determine whether HIV suppression is associated with lower risk of progression to end-stage renal disease (ESRD) among HIV-positive African Americans with biopsy-confirmed classic FSGS. Methods: HIV-positive African Americans who underwent kidney biopsies at a single tertiary hospital between January 1996 and June 2011 were confirmed as having classic FSGS by the presence of segmental glomerulosclerosis without features of HIV-associated nephropathy. Multivariable Cox proportional hazards models were used to examine the independent association of viral suppression (HIV-RNA, 400 copies per milliliter at biopsy) with time to progression to ESRD. Results: Of the 55 HIV-positive African Americans with classic FSGS, 26 had suppressed viral loads at the time of biopsy. Compared to viremic patients, those who were virally suppressed had a significantly higher mean CD4+ cell count (452 vs. 260 cell/mm3, respectively; P = 0.02) and median estimated glomerular filtration rate (53.5 vs 35.5 mL/min/ 1.73 m2, respectively; P = 0.002). Adjusting for sex and baseline CD4+ cell count, estimated glomerular filtration rate, and proteinuria, those with HIV-RNA levels,400 copies per milliliter at baseline had a 75% lower risk of progressing to ESRD (hazard ratio = 0.25; 95% CI: 0.07 to 0.88) during a median follow-up time of 2.70 years (interquartile range: 0.80-5.15 years). Conclusions: HIV suppression is associated with significantly lower risk of progression to ESRD among HIV-infected African Americans with classic FSGS, supporting the potential role of combined antiretroviral therapy for this histopathology in addition to HIV-associated nephropathy among HIV-positive individuals.
KW - Chronic kidney disease
KW - Classic focal segmental glomerulosclerosis
KW - HIV-infected patients
KW - Renal biopsy
KW - Viral suppression
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U2 - 10.1097/QAI.0000000000001860
DO - 10.1097/QAI.0000000000001860
M3 - Article
C2 - 30204721
AN - SCOPUS:85056322966
SN - 1525-4135
VL - 79
SP - 639
EP - 643
JO - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
JF - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
IS - 5
ER -