ATLANTA—Chronic kidney disease (CKD) is more likely to develop among older rather than younger HIV-positive individuals, researchers reported at the 20th Conference on Retroviruses and Opportunistic Infections.
Compared with individuals aged 18-39 years, those aged 40-59 and 60 and older are at 2.8-fold and 7.8-fold increased risk for CKD, respective, based on 2009 data from the Medical Monitoring Project (MMP), which involves 23 health departments across the U.S. and focuses on clinical outcomes and behaviors of HIV-infected individuals. It is led by Jacek Skarbinski, MD.
Investigators concluded that health care providers should routinely screen HIV-positive adults for CKD, particularly those over age 60. They also recommend that when CKD is detected in these patients, they should be referred as quickly as possible to a nephrologist and not be given nephrotoxic agents. All HIV-positive adults also should have “aggressive management of comorbid conditions such as diabetes, hypertension and obesity,” according to lead investigator Shikha Garg, MD, and his colleagues.
Dr. Garg, of the Centers for Disease Control and Prevention in Atlanta, led the analysis of CKD prevalence among HIV-positive adults. They focused on the 3,814 adults in the MMP from 2009 who were both HIV-positive and had at least one recorded creatinine measurement.
They found 5.7% of the HIV-infected adults had stage 3 CKD, 0.6 had stage 4 CKD, and 1.3% were on dialysis.
In adjusted analyses, women were 40% more likely than men and individuals who had HIV for 10 or more years were 40% more likely to have CKD than those who had HIV for a shorter period. CKD also was more likely among those with full-blown AIDS.
Somewhat surprisingly, having an HIV viral load that was undetectable or no more than 200 copies/mL3 was also associated with an increased prevalence of CKD. Older HIV-positive adults from the MMP had a lower CKD prevalence than similarly aged individuals from the 2001-2006 National Health and Nutritional Examination Survey (NHANES) database. Individuals aged 60 and older from the MMP had a 0.8 prevalence ratio of CKD compared with adults aged 60 and over from the NHANES. The respective ratios for the age 18-39 and 40-59 age groups were 4.6 and 1.8.
Dr. Garg said the lower CKD prevalence among older HIV-infected adults is puzzling. “One potential explanation is that people with HIV infection who are sicker or have many comorbid conditions may die earlier than HIV-uninfected persons of the same age and with the same types of comorbid conditions,” Dr. Garg said. “This would result in our having compared a healthier older HIV-infected population – that is, those who did not die earlier – to a potentially sicker non-HIV-infected older population.”