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Hepatitis C seropositivity and kidney function decline among women with HIV: data from the Women's Interagency HIV
Judith Tsui1, Eric Vittinghoff, Kathryn Anastos
1Boston University School of Medicine, Boston, MA 02118, USA. judith.tsui@bmc.edu
Insights
Hepatitis C virus (HCV) coinfection significantly accelerates kidney function decline in women with HIV and chronic kidney disease (CKD). This highlights the need for vigilant kidney monitoring in coinfected patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- The impact of hepatitis C virus (HCV) coinfection on kidney function trajectory in human immunodeficiency virus (HIV)-infected individuals remains incompletely understood.
- This study investigated the longitudinal effects of HCV infection on renal function among women living with HIV.
Purpose of the Study:
- To determine the association between HCV seropositivity and the rate of change in estimated glomerular filtration rate (eGFR) over time in HIV-infected women.
- To assess whether this association differs based on baseline kidney function.
Main Methods:
- A retrospective observational cohort study utilizing data from the Women's Interagency HIV Study.
- HCV status was determined by antibody testing, and kidney function was assessed by eGFR calculated using the Modification of Diet in Renal Diseases (MDRD) Study equation.
- Linear mixed models were employed to analyze the independent effect of HCV seropositivity on eGFR, adjusting for various confounders and interaction with baseline eGFR.
Main Results:
- Among 2,684 HIV-infected women, 35% were HCV seropositive.
- In women with chronic kidney disease (CKD) at baseline (eGFR < 60 mL/min/1.73 m(2)), HCV seropositivity was independently associated with a 5% annual decrease in eGFR.
- No significant association was observed in women without CKD at baseline, indicating a significant interaction (P < 0.001).
Conclusions:
- HCV coinfection is linked to a significant, albeit modest, decline in kidney function among HIV-infected women with pre-existing CKD.
- The MDRD equation's validation in this population and the exclusion of proteinuria are noted limitations.
- Enhanced monitoring of renal function is recommended for HIV-infected patients with CKD who are coinfected with HCV.
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 m(2)).
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 m(2)), 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.
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