Journal Article

HIV Care and the Incidence of Acute Renal Failure

Jennifer Roe, Lucy J. Campbell, Fowzia Ibrahim, Bruce M. Hendry and Frank A. Post

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 2, pages 242-249
Published in print July 2008 | ISSN: 1058-4838
Published online July 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/589296
HIV Care and the Incidence of Acute Renal Failure

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Background. The clinical epidemiology of acute renal failure (ARF) in human immunodeficiency virus (HIV)-infected patients remains poorly defined.

Methods. We conducted a retrospective analysis of patients who developed ARF while attending King's College Hospital (London, United Kingdom) during January 1998-December 2005. Serum creatinine level and estimated glomerular filtration rate were used to identify ARF. ARF episodes were classified as early onset if they occurred <3 months after initiation of HIV care and as late onset if they occurred ⩾3 months after initiation of HIV care.

Results During the study period, 130 (5.7%) of 2274 patients developed 144 episodes of ARF. The incidences of early-onset and late-onset ARF were 19.3 episodes per 100 person-years (95% confidence interval [CI], 15.4–24.1 episodes per 100 person-years) and 1.1 episodes per 100 person-years (95% CI, 0.83–1.49 episodes per 100 person-years), respectively (rate ratio, 17.4; P<.001). In multivariate analysis, nadir CD4 T cell count <100×109 cells/L (odds ratio [OR], 6.7; 95% CI, 2.5–18.3) and acquired immunodeficiency syndrome (OR, 6.7; 95% CI, 3.4–13.3) were associated with early-onset ARF, whereas injection drug use (OR, 4.8; 95% CI, 1.3–17.7), hepatitis C virus coinfection (OR, 3.4; 95% CI, 1.3–8.6), and nadir CD4 T cell count <100×109 cells/L (OR, 5.8; 95% CI, 2.5–13.4) were associated with late-onset ARF.

Conclusions. ARF was common and was associated with advanced immunodeficiency. The incidence of ARF decreased >10-fold in patients who had received HIV care for ⩾3 months.

Journal Article.  3919 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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