Renal Disease in Diabetics with HIV

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NEW ORLEANS—Patients who have type 2 diabetes and are infected with HIV have a higher rate of microalbuminuria than either HIV-positive patients without diabetes or diabetics without HIV infection, researchers announced here at the American Diabetes Association's Annual Meeting.

“The cumulative risk for microalbuminuria that results when diabetes and HIV infection coexist means that doctors need to consider screening for early evidence of kidney injury in this at-risk population,” said Colleen Hadigan, MD, MPH, a staff clinician in the Laboratory of Immunoregulation at the National Institute of Allergy and Infectious Diseases in Bethesda, Md.

She and her colleagues conducted a cross-sectional study of three cohorts: 100 HIV-positive adults with type 2 diabetes or impaired fasting glucose, 82 HIV-positive nondiabetics, and 62 type 2 diabetics without HIV infection.
The prevalence of microalbuminuria (defined as albumin-to-creatinine ratio greater than 30 mg/g) was 34% in the HIV-positive diabetic group compared with 13% and 16% in HIV-positive nondiabetics and diabetic controls, respectively.

“As the life expectancy of HIV-infected patients increases with the use of antiretroviral therapy, chronic medical conditions, such as renal failure, are increasingly prevalent,” Dr. Hadigan and colleagues wrote in their poster presentation. “In addition, the prevalence of type 2 diabetes is increased among HIV-infected patients and is associated with cumulative exposure to antiretroviral therapy.”

The effects of both diabetes and HIV infection on renal disease have been widely reported, they said. However, little is known about renal disease in HIV-infected patients with type 2 diabetes, and no previous reports have characterized microalbuminuria in HIV-positive patients with diabetes.

After controlling for known risk factors for microalbuminuria, such as increasing age and elevated BP, “patients who were HIV-positive and had diabetes were approximately two times more likely to have microalbuminuria than HIV-positive patients without diabetes or HIV-negative diabetic patients,” Dr. Hadigan said.

Serum biomarkers were not significantly associated with the albumin-to-creatinine ratio, the study showed. “This suggests that elevations in albumin-to-creatinine ratio may not be linked directly to recent levels of inflammation but may be related to chronic infection, inflammation, and/or persistent hyperglycemia,” she noted.

Possible study limitations, Dr. Hadigan pointed out, include a single determination of urinary albumin-to-creatinine ratio and the cross-sectional study design.
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