Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis

Fakhrul M Islam,David P Wilson,James Jansson,Jianyun Wu

doi:10.1186/1471-2458-12-234

Fakhrul M Islam, David P Wilson + Show 2 more

Open Access

https://doi.org/10.1186/1471-2458-12-234

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Journal: BMC Public Health	Publication Date: Mar 23, 2012
Citations: 114	License type: cc-by

Affiliation: UNSW Sydney, St Vincent's Hospital Sydney

Abstract

BackgroundAntiretroviral therapy (ART) has substantially decreased mortality and HIV-related morbidity. However, other morbidities appear to be more common among PLHIV than in the general population. This study aimed to estimate the relative risk of renal disease among people living with HIV (PLHIV) compared to the HIV-uninfected population.MethodsWe conducted a systematic review and meta-analysis of relative risks of renal disease among populations of PLHIV reported in studies from the peer-reviewed literature. We searched Medline for relevant journal articles published before September 2010, yielding papers published during or after 2002. We also searched conference proceedings of the International AIDS Society (IAS) and Conference on Retroviruses and Opportunistic Infections (CROI) prior to and including 2010. Eligible studies were observational studies reporting renal disease defined as acute or chronic reduced renal function with glomerular filtration rate less than or equal to 60 ml/min/1.73 m2 among HIV-positive adults. Pooled relative risks were calculated for various groupings, including class of ART drugs administered.ResultsThe overall relative risk of renal disease was 3.87 (95% CI: 2.85-6.85) among HIV-infected people compared to HIV-uninfected people. The relative risk of renal disease among people with late-stage HIV infection (AIDS) was 3.32 (1.86-5.93) compared to other PLHIV. The relative risk of renal disease among PLHIV who were receiving antiretroviral therapy (ART) was 0.54 (0.29-0.99) compared to treatment-naïve PLHIV; the relative risk of renal disease among PLHIV who were treated with tenofovir was 1.56 (0.83-2.93) compared to PLHIV who were treated with non-tenofovir therapy. The risk of renal disease was also found to significantly increase with age.ConclusionPLHIV are at increased risk of renal disease, with greater risk at later stages of infection and at older ages. ART prolongs survival and decreases the risk of renal disease. However, less reduction in renal disease risk occurs for Tenofovir-containing ART than for other regimens.

Highlights

Antiretroviral therapy (ART) has substantially decreased mortality and HIV-related morbidity
There is a complex spectrum of renal diseases, such as HIV-associated nephropathy (HIVAN), end-stage renal disease (ESRD), all-cause nephropathy (ACN), acute renal failure (ARF), chronic kidney disease (CKD), chronic renal failure (CRF), tubular dysfunction, and renal impairment (RI), which can be classified within Chronic kidney disease (CKD) stages 3, 4 and 5 based on the outcome measure in each individual study
Study selection The search strategy initially resulted in 4083 articles from which we identified 361 for detailed review

Summary

Introduction

Antiretroviral therapy (ART) has substantially decreased mortality and HIV-related morbidity. This study aimed to estimate the relative risk of renal disease among people living with HIV (PLHIV) compared to the HIV-uninfected population. Active antiretroviral treatment (ART) has reduced mortality and decreased HIV-related morbidities, such that people living with HIV (PLHIV) are living longer, healthier lives [1]. Numerous serious morbidities are more likely to occur among PLHIV than among the general population. There is no consensus on the risk of renal dysfunction associated with HIV infection and the use of ART, it is believed to be an important condition disproportionately affecting PLHIV [2,3,4]. Numerous studies have investigated the rates of renal disease and its risk factors for PLHIV.

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