21 May 2013
Estimated glomerular filtration rate (eGFR) declined at a similar annual pace in antiretroviral-treated women with HIV and women without HIV in the US Women’s Interagency HIV Study (WIHS). But HIV-positive women had significantly lower average eGFRs at follow-up than did HIV-negative women.
Research suggests that HIV infection accelerates kidney function decline, but few studies have actually compared kidney function over time in HIV-positive people and matched HIV-negative individuals. WIHS investigators conducted this study of kidney function change in women with HIV (105 taking tenofovir and 373 not taking tenofovir) and HIV-negative women matched to the HIV group by length of follow-up, age, systolic blood pressure, hepatitis C antibody serostatus, and diabetes history. The researchers used linear mixed models to explore differences in annual eGFR between the two HIV groups and the HIV-negative group.
Person-years of follow-up measured 4741 for tenofovir-treated women and 11,512 for women who did not take tenofovir. Average initial eGFR was higher (better) among women who began a tenofovir regimen than among HIV-negative women in the comparison group (P < 0.05). For HIV-positive women who began a nontenofovir regimen, average initial eGFR was lower than among HIV-negative women (P < 0.05).
Annual rates of eGFR change were similar in women with and without HIV (P > 0.05).
An analysis adjusted for initial eGFR determined that eGFRs after 1 and 3 years of follow-up among HIV-positive women starting a tenofovir regimen were significantly lower (worse) than in the HIV-negative comparison group (−4.98 and −4.26 mL/min/1.73 m(2) respectively, P < 0.05 for both). Among HIV-positive women starting a nontenofovir regimen, average eGFR after 5 years of follow-up was also significantly lower than in the HIV-negative comparison group (–2.19 ml/min/1.73 m(2), P = 0.03).
Antiretroviral-treated “HIV-infected women had lower mean eGFRs at follow-up but experienced rates of annual eGFR decline similar to HIV-uninfected women,” the WIHS investigators conclude.
“Tenofovir use in HIV-infected women with normal kidney function,” they add, “did not accelerate long-term kidney function decline relative to HIV-uninfected women.”
Source: Michelle M. Estrella, Alison G. Abraham, Yuezhou Jing, Rulan S. Parekh, Phyllis C. Tien, Dan Merenstein, Celeste Leigh Pearce, Kathryn Anastos, Mardge H. Cohen, Jack A. Dehovitz, Stephen J. Gange. Antiretroviral-treated HIV-infected women have similar long-term kidney function trajectories as HIV-uninfected women. AIDS Research and Human Retroviruses. 2013; 29: 755-760.
For the study abstract
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