Abstract
BackgroundThe Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014.MethodsA retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI.ResultsThree hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5–10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40–2.99]), infection (OR 5.48 [95% CI 2.65–11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03–1.45]).ConclusionRhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality.
Highlights
The Literature on rhabdomyolysis in the Human immunodeficiency virus (HIV)-positive population is sparse and limited
Patients were identified through the review of the laboratory records of those enrolled in Johns Hopkins HIV clinical registry between June 1992 and April 2014
Incidence of Rhabdomyolysis The HIV Clinical registry consisted of 7079 patients with 38,382 person-years of follow-up during the study period of June 1992 to April 2014
Summary
The Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014. A cohort study from Kaiser Permanente reported a 10-fold higher incidence of rhabdomyolysis among the HIVpositive compared with HIV-negative individuals (265 events/100,000 py versus 26 events/100,000 py; 95% CI: 8.5–12.0; p < 0.001) [1]. Despite the notably higher incidence of rhabdomyolysis among HIV-positive persons, the literature in this patient population is sparse. To more comprehensively evaluate the risk factors for rhabdomyolysis and its impact on clinical outcomes in the context of HIV infection, we aimed to investigate the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a large cohort of HIV-positive patients
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