Evolving chronic disease management in HIV care in an era of improved long-term survival.

Abstract

Adults ageing with HIV and on antiretroviral therapy have a greater burden of chronic diseases compared with adults without HIV as reported by Althoff et al. (Curr Opin HIV AIDS 11:527-36, 2016). Therefore, it is important in this clinically stable HIV+ population to monitor and evaluate their risk of chronic kidney disease and intervene when appropriate. The European AIDS Clinical Society (EACS) advise that yearly screening for CKD with eGFR calculation and spot urine protein measurements should be performed (European AIDS Clinical SocietyGuidelines 2018). The Centre for Excellence for Health, Immunity and Infection (CHIP) have created a validated study calculator to estimate a patient's risk for CKD as reported by Mocroft et al. (PLoS Med 12(3):e1001809, 2015). (1) To determine the proportion of patients who had a urinary protein-creatinine ratio checked in 2018; (2) To calculate an eGFR for each patient in our cohort utilizing the Modification of Diet in Renal Disease (MDRD) calculation; (3) To calculate the full chronic kidney disease score in our cohort of patients. We undertook a retrospective chart review of 80 HIV-positive patients who attended our weekly clinic in Beaumont Hospital, Dublin, Ireland. In our subset of 31 patients who had all the requirements to estimate their eGFR and full chronic kidney disease risk score, 100% (31/31) of eGFRs calculated were reported as > 90mL/min/1.73m2. The median eGFR was 215mL/min/1.73m2 (range 95.69-418.08mL/min/1.73m2). The average CHIP full chronic kidney disease 5-year risk score for patients developing CKD was 0.91% (95% CI 0.60-1.21%). One patient was identified with a risk score of 5.05% as they had suffered an acute coronary syndrome event in the past. Although this audit was small and with limitations, it highlights the importance of collecting relevant and accurate patient data annually to estimate and mitigate the risk of chronic kidney disease in patients with HIV.