Racial Differences in End-Stage Renal Disease Rates in HIV Infection versus Diabetes
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.
Available from: jid.oxfordjournals.org
- "One difference between the 2 studies is that only 6% of subjects in the EuroSIDA study were black, whereas approximately 40% of subjects in NA-ACCORD were black. Black individuals are at increased risk for CKD compared with white individuals [32, 33]. When we stratified our outcome analyses by race, we could find no consistent evidence that HCV associations with CKD differed by race, although CIs were wide. "
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The role of active hepatitis C virus (HCV) replication in chronic kidney disease (CKD) risk has not been clarified.
We compared CKD incidence in a large cohort of HIV-infected subjects who were HCV seronegative, HCV viremic (detectable HCV RNA), or HCV aviremic (HCV seropositive, undetectable HCV RNA). Stages 3 and 5 CKD were defined according to standard criteria. Progressive CKD was defined as a sustained 25% glomerular filtration rate (GFR) decrease from baseline to a GFR < 60 mL/min/1.73 m2. We used Cox models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).
A total of 52 602 HCV seronegative, 9508 HCV viremic, and 913 HCV aviremic subjects were included. Compared with HCV seronegative subjects, HCV viremic subjects were at increased risk for stage 3 CKD (adjusted HR 1.36 [95% CI, 1.26, 1.46]), stage 5 CKD (1.95 [1.64, 2.31]), and progressive CKD (1.31 [1.19, 1.44]), while HCV aviremic subjects were also at increased risk for stage 3 CKD (1.19 [0.98, 1.45]), stage 5 CKD (1.69 [1.07, 2.65]), and progressive CKD (1.31 [1.02, 1.68]).
Compared with HIV-infected subjects who were HCV seronegative, both HCV viremic and HCV aviremic individuals were at increased risk for moderate and advanced CKD.
Available from: PubMed Central
- "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. "
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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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