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Kidney disease in antiretroviralnaïve HIV-positive adults with high CD4: prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment trial #MMPMID25711324
Achhra A; Mocroft A; Ross M; Ryom L; Lucas G; Furrer H; Neuhaus J; Somboonwit C; Kelly M; Gatell J; Wyatt C
HIV Med 2015[Apr]; 16 (0 1): 55-63 PMID25711324show ga
Introduction: HIV infection has been associated with increased risk of chronic kidney disease (CKD). Little is known about the prevalence of CKD in individuals with high CD4 cell counts prior to initiation of antiretroviral therapy (ART). Methods: We describe the prevalence of CKD among 4637 ART-naïve adults (mean age 36.8 years) with CD4 cell counts >500 cells/?L at enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. CKD was defined by estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 and/ or dipstick urine protein ?1+. Logistic regression was used to identify baseline characteristics associated with CKD. Results: Among 286 (6.2%, 95% CI 5.5%, 6.9%) participants with CKD, the majority had isolated proteinuria. 268 participants had urine protein ?1+, including 41 with urine protein ?2+. Only 22 participants (0.5%) had an estimated glomerular filtration rate <60mL/min/1.73m2, including 4 who also had proteinuria. Baseline characteristics independently associated with CKD included diabetes (adjusted odds ratio, aOR 1.73, 95% CI 1.05, 2.85), hypertension (aOR 1.82, 95% CI 1.38, 2.38), and race/ ethnicity (aOR 0.59, 95% CI 0.37, 0.93 for Hispanic versus white). Discussion: We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-naïve clinical trial participants with CD4 cell counts >500 cells/?L.