Few studies have compared the incidence of end-stage renal disease (ESRD) among individuals with the human immunodeficiency virus (HIV) and diabetes. We followed a national sample of 2,015,891 US veterans over a median peroid of 3.7 years for progression to ESRD. The age- and sex-adjusted incidence of ESRD (per 1000 person-years) among HIV-infected black patients was nearly an order of magnitude higher than among HIV-positive white patients, almost twice that of diabetic whites, and similar to that among diabetic blacks. In multivariate Cox proportional hazards analysis, diabetes was associated with an increased risk of ESRD among white patients, but HIV was not. Among black individuals, however, both HIV and diabetes conferred a similar increase in the risk of ESRD (4- to 5-fold increase compared to white individuals without HIV or diabetes). HIV and diabetes carry a similar risk of ESRD among black patients, highlighting the importance of developing strategies to prevent and treat renal disease among HIV-infected black individuals.
"Additionally, on average in adults, the glomerular filtration rate decreases about 1% per year with increasing age,55 and the methods for estimating renal function may overestimate this function in older adults by not taking their lowered relative muscle mass into account.56 In older adults with HIV, this problem is further complicated because this population characteristically has lower muscle mass than their counterparts and often, confounding factors that can further decrease renal function – diabetes mellitus, hypertension, low CD4 cell count, race, and use of the antiretrovirals tenofovir and indinavir.57–60 Estimating renal function is therefore even more difficult in HIV-infected older adults and affects the dosing and prescription of renally excreted medications. "
[Show abstract][Hide abstract] ABSTRACT: The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. Older HIV-infected patients are particularly at risk for polypharmacy because they often have multiple comorbidities that require pharmacotherapy. Overall, there is not much known with respect to both the impact of aging on medication use in HIV-infected individuals, and the potential for interactions with highly active antiretroviral therapy (HAART) and coadministered medications and its clinical consequences. In this review, we aim to provide an overview of polypharmacy with a focus on its impact on the HIV-infected older adult population and to also provide some clinical considerations in this high-risk population.
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