Kidney disease risk increased for patients with HIV and hepatitis C

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People who are both HIV and hepatitis C infected are at significantly higher risk of kidney disease compared to those with HIV only, say US researchers in a study published in the September 12th edition of AIDS.

Chronic kidney disease and its most serious form, end-stage renal disease, is more common in HIV infected individuals. Now researchers at the Mount Sinai School of Medicine have attempted to find out what effect HIV/hepatitis C coinfection had on the risk of developing chronic kidney disease.

They reviewed the data from any study which looked at chronic kidney disease and HIV infection but also recorded hepatitis C infection status. A total of 24 studies were included in their analysis.

Glossary

renal

Relating to the kidneys.

end-stage disease

Final period or phase in the course of a disease leading to a person's death.

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

relative risk

Comparing one group with another, expresses differences in the risk of something happening. For example, in comparison with group A, people in group B have a relative risk of 3 of being ill (they are three times as likely to get ill). A relative risk above 1 means the risk is higher in the group of interest; a relative risk below 1 means the risk is lower. 

protein

A substance which forms the structure of most cells and enzymes.

They found that chronic kidney disease was 49% more likely in those with co-infection, compared to those with HIV infection alone (6.2% versus 4% , relative risk 1.49, 95%CI 1.08-2.06). (Wyatt 2008).

But the researchers also looked at two other parameters of kidney disease. The first was proteinuria, the presence of protein in the urine which is an early sign of kidney disease. The second is acute renal failure – a sign of very advanced disease.

They found that hepatitis coinfection was associated with a 15% rise in the risk of proteinuria and a 64% rise in the risk of acute renal failure. They also found an increased risk of kidney problem with the protease inhibitor indinavir.

HIV guidelines already stress that hepatitis C coinfection is a risk factor for kidney disease and recommend doctors check regularly for proteinuria and regularly monitor patients’ estimated glomerular filtration rate (eGFR) – a test of kidney function.

The authors say their results reinforce the importance of these recommendations as early recognition of kidney disease can allow targeted treatment and hopefully delay progression to more serious kidney disease and end stage renal disease.

It is also essential to guide the selection of and dosing of antiretroviral therapy, although they add routine reporting of hepatitis C status has not been a part of most clinical trials.

The researchers also looked at the impact of race on chronic kidney disease in coinfected patients and found that black patients were 25% more likely to have chronic kidney disease.

The results echo another study published earlier this year which suggested HIV-infected African-Americans who develop kidney disease are more likely to have a more aggressive form of the disease than white people (Lucas 2008).

References

Wyatt CM et al. The impact of hepatitis C virus coinfection on HIV-related kidney disease: a systematic review and meta-analysis. AIDS 22:1799-1807, 2008.

Lucas GM, Lau B et al. Chronic kidney disease incidence and progression to end-stage renal disease in HIV-infected individuals: a tale of two races. Journal of Infectious Diseases 197, 2008.