Abstract
Among people with perinatal HIV infection (PHIV), non-communicable diseases, such as chronic kidney disease, are increasing. Both HIV replication and antiretroviral therapy are recognised causes of renal impairment. Objective of the study is to describe the impact of viremia copy-years (VCY) and antiretroviral therapy on trend of estimated glomerular filtration rate (eGFR) in a cohort of adults with perinatal HIV infection. We conducted a multicentre observational study in sixty adults living with PHIV across a 9-year period, from January 2010 to December 2018. The mean values of eGFR were analysed at the first (T0) and last year of observation (T1). VCY was defined as the area under HIV-RNA curve during the study period. We analysed data according to antiretroviral therapy: tenofovir disoproxil (TDF), non-nucleoside reverse transcriptase inhibitors (NNRTI), boosted protease inhibitors (PI/b), integrase inhibitors (INI). We observed a mean overall eGFR reduction from 126.6 mL/min (95%CI: 119.6–133.5) to 105.0 mL/min (95%CI: 99.55–110.6) (p<0.001). Older age, higher baseline eGFR, higher VCY and longer exposure to INI treatment were associated with eGFR reduction at univariate analysis. In the multivariate model, older age (p = 0.039), baseline eGFR (p<0.001) and VCY (p = 0.069), were retained. We also observed a longer exposure to PI/b and INI in patients with lower control on HIV-RNA, expressed as VCY>2 log10. Our study outlines a progressive eGFR reduction in young adults with PHIV, related to the lower control on HIV-RNA VCY and related to aging.
Highlights
Since the early 2000s, there has been a gradual reduction of perinatal HIV infection (PHIV), owing to the extensive use of modern antiretroviral therapy (ART) in pregnant women and prophylaxis in newborns [1, 2]
Parallel to the declining prevalence of perinatal HIV infection (PHIV) in the youngest age group, there has been an increase in the number of adolescents and young adults living with HIV, whose better quality of life and longer survival periods can be attributed to the immune-virological success of modern ART [3, 4]
Another key objective in patients with PHIV is maintaining the HIV-RNA below 50 copies/mL, which is often challenging due to the high frequency of drug resistance mutations since it is well established that a higher viremia copyyears (VCY)–expression of the cumulative HIV-RNA load over time—is associated with increased morbidity and mortality [10,11,12,13]
Summary
Since the early 2000s, there has been a gradual reduction of perinatal HIV infection (PHIV), owing to the extensive use of modern antiretroviral therapy (ART) in pregnant women and prophylaxis in newborns [1, 2]. The prevention of premature aging and long-term adverse outcomes is becoming increasingly important One of these outcomes is chronic kidney disease (CKD), usually defined as a pathological decline in estimated glomerular filtration rate (eGFR) [5,6,7]. The normal eGFR in young adults is approximately 125 mL/min and an age-related eGFR decline of 1.49±0.61 mL/min per decade is described in the literature [8, 9] Another key objective in patients with PHIV is maintaining the HIV-RNA below 50 copies/mL, which is often challenging due to the high frequency of drug resistance mutations since it is well established that a higher viremia copyyears (VCY)–expression of the cumulative HIV-RNA load over time—is associated with increased morbidity and mortality [10,11,12,13]. Our study seeks to describe the impact of VCY in the eGFR trend in a multicentric cohort of adults living with PHIV across a 9 years’ observation period and to investigate the possible influence of different ART strategies (TDF-, NNRTI-, INI- or PI/b-containing regimens) on this trend
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