Provided by The International AIDS Society
Author: Mark Mascolini
18 November 2013
Both viremic and aviremic HCV infection independently raised the risk of moderate, advanced, and progressive chronic kidney disease (CKD) in a large study of North Americans with HIV infection.
Because the impact of HCV infection on CKD in people with HIV is poorly understood, NA-ACCORD investigators conducted this study of three HIV-positive groups: 52,602 HCV-seronegative people, 9508 HCV-viremic people (HCV seropositive with detectable HCV RNA), and 913 HCV-aviremic people (HCV seropositive but undetectable HCV RNA).
The researchers defined stage 3 CKD as two or more glomerular filtration rates (GFRs) below 60 mL/min separated by at least 90 days; they defined stage 5 CKD as two or more GFRs below 15 mL/min separated by at least 90 days; and they defined progressive CKD as a sustained 25% GFR decrease from baseline to below 60 mL/min.
Median ages of the HCV-negative, HCV-viremic, and HCV-aviremic groups were 41, 47, and 44. Proportions of blacks were 38%, 58%, and 37%. Proportions taking antiretroviral therapy were 43%, 45%, and 42%. Median GFR in the three groups measured 102, 103, and 100 mL/min.
Compared with HCV-seronegative people, HCV-viremic people and HCV-aviremic people ran higher risks of stage 3 CKD, stage 5 CKD, and progressive CKD at the following adjusted hazard ratios (aHR) (and 95% confidence intervals):
• Risk of stage 3 CKD: aHR 1.36 (95% CI 1.26 to 1.46)
• Risk of stage 5 CKD: aHR 1.95 (95% CI 1.64 to 2.31)
• Risk of progressive CKD: aHR 1.31 (95% CI 1.19 to 1.44)
• Risk of stage 3 CKD: aHR 1.19 (95% CI 0.98 to 1.45, not significant)
• Risk of stage 5 CKD: aHR 1.69 (95% CI 1.07, 2.65)
• Risk of progressive CKD: aHR 1.31 (95% CI 1.02 to 1.68)
The study found no statistically significant differences in risk of CKD outcome between HCV-viremic and HCV-aviremic people. The NA-ACCORD team determined that “factors other than chronic HCV replication appear to account for most of the observed association between HCV infection and CKD.”
The researchers conclude that, compared with HCV-negative people, “both HCV viremic and HCV aviremic individuals were at increased risk for moderate and advanced CKD.”
Source: Gregory M. Lucas, Yuezhou Jing, Mark Sulkowski, Alison G. Abraham, Michelle M. Estrella, Mohamed G. Atta, Derek M. Fine, Marina B. Klein, Michael J. Silverberg, M. John Gill, Richard D. Moore, Kelly A. Gebo, Timothy R. Sterling, Adeel A. Butt, for the NA-ACCORD of the IeDEA. Hepatitis C viremia and the risk of chronic kidney disease in HIV-infected individuals. Journal of Infectious Diseases. 2013; 208: 1240-1249.
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