People living with HIV (PLWH) who are hospitalized with COVID-19 have a high incidence of acute kidney injury (AKI), and their risk for AKI appears to be independent of HIV-specific risk factors, investigators reported at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference.
In addition, elevated markers of inflammation may predict development of AKI.
Molly Fisher, DO, of the Division of Nephrology at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, New York, and colleagues retrospectively studied 83 PLWH hospitalized with COVID-19 within the Montefiore Health System. AKI developed in 45 patients (54.2%). The patients with AKI were significantly older than those with no AKI (64 vs 60 years) and had a significantly higher prevalence of hypertension (77.8% vs 55.3%).
The AKI and no-AKI groups had similar proportions of patients with suppressed HIV-1 RNA viral load (less than 40 copies/mL; 84.1% vs 83.3%, respectively), unsuppressed viral load (15.9% vs 16.7%), and patients who reported antiretroviral therapy (ART) use in the past year (95.6% vs 92.1%).
Although CD4 T-cell count was lower in patients with AKI compared with those who did not have AKI (351 vs 445 cells/mL), the difference was not statistically significant.
Dr Fisher’s team did not identify HIV-specific risk factors, including CD4 T-cell count, viral suppression, ART type, tenofovir use, or HIV transmission risk for AKI in the setting of COVID-19, but they noted that their study may have been underpowered to detect such differences.
Compared with the no-AKI group, the patients with AKI had higher white blood cell and neutrophil counts, C-reactive protein, interleukin-6, and other markers of inflammation.
Of the 45 patients with AKI, 10 (22.2%) required renal replacement therapy (RRT) and 18 (40%) required invasive ventilation.
No patient with unsuppressed viremia required RRT, invasive ventilation, or died in the hospital, according to the investigators.
“Although limited by small sample size, we hypothesize an altered immune response in those HIV-positive patients with unsuppressed viremia may mitigate the cytokine surge associated with severe COVID-19 and worse outcomes,” Dr Fisher said. “Further studies are needed to explore whether HIV-positive patients with unsuppressed viremia have a milder disease course associated with COVID-19 as well as to investigate long-term sequelae such as CKD progression in HIV-positive patients following COVID-19-associated AKI.”
Fisher M, Fazzari M, Hanna D, et al. Acute kidney injury in people living with HIV hospitalized with COVID-19. Presented at: Kidney Week 2020 Reimagined virtual conference, October 19-25. Poster PO0677.