Abstract
BackgroundRenal dysfunction is a common problem in the HIV+ population, due to the effect of both the HIV virus and the several classes of ARV drugs such as tenofovir (TDF). It is also known that the presence of renal damage correlates with cardiovascular risk and therefore with the risk of mortality of the patients accordingly. The detection of early renal damage is very important. Albuminuria and microalbuminuria are markers of early kidney disease and cardiovascular risk. The aim of the study is to evaluate the prevalence of microalbuminuria in a large polycentric sample, of unselected and consecutive HIV-patients followed as outpatients, and to assess its association with different therapeutic regimens.MethodsWe studied 326 patients with a mean age of 48.4 ± 1.6 years, treated at the Infectious Diseases Clinics of Chieti and Perugia for 48 weeks. The main metabolic parameters and the microalbuminuria levels in a single sample of urine were evaluated.ResultsMicroalbuminuria was detected in 61.0% of patients at T0 and in 49.7% after 48 weeks of observation with a median values of 1.1 mg/L (IQR: 0-2.7) vs. 0 mg/L (IQR: 0-2.0). 70% of the enrolled population did not show changes in microalbuminuria levels over time, 19% showed improvement, and 11% of the population had a worsening of microalbuminuria levels without any alteration of creatinine, uric acid and GFR-MDRD. We also found a statistically significant association between the development of microalbuminuria and gender (p < 0.035), Arterial Hypertension (AH) (p < 0.028) and therapy with TDF (p < 0.050).ConclusionWe showed a very high prevalence of microalbuminuria, much higher than the literature data; the use of TDF affects the renal function in a statistically significant way and should therefore be considered a risk factor for kidney damage, which can be early assessed with the measurement of microalbuminuria.
Highlights
Renal dysfunction is a common problem in the HIV+ population, due to the effect of both the HIV virus and the several classes of ARV drugs such as tenofovir (TDF)
We consecutively enrolled in this crosssectional study 326 HIV-infected patients on antiretroviral therapy (ART), with no evidence of kidney disease, who were being referred to the Day Hospital of Infectious Diseases, Department of Medicine and Science of Ageing, “G. d’Annunzio” University (Chieti-Pescara, Italy) and to the Day Hospital of Infectious Diseases Department of Medicine, University of Perugia (Perugia, Italy)
By splitting the patients into 3 subgroups (Equal, Improved and Worse), we showed that during the study period there was no change in the presence of microalbuminuria in 70.0% of the cases, we found an improvement in 19.0% of patients, and a worsening in 11.0% of them (Fig. 2)
Summary
Renal dysfunction is a common problem in the HIV+ population, due to the effect of both the HIV virus and the several classes of ARV drugs such as tenofovir (TDF). Albuminuria and microalbuminuria are markers of early kidney disease and cardiovascular risk. HIV infection is an early atherosclerotic and vascular disease risk factor leading to an increased risk of cardiovascular events in comparison with HIV negative [1]. The renal disease is increasing as a HIV patients typically have 10 years a cardiovascular risk higher than non-HIV (DAD) [3]. Microalbuminuria is a widely recognized early marker of renal dysfunction [6], which can be and reliably expressed by urine albumin-to-creatinine ratio (UACR) [7]. Microalbuminuria often complicates the course of HIV infection [9], being associated with an increased risk of future CV disease events [10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
