Clinical characteristics of 10 HIV-infected patients who developed end-stage renal disease

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  • Sekiya Noritaka
    Department of Nephrology, Tokyo Metropolitan Komagome Hospital Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital
  • Nakamura Yuya
    Department of Nephrology, Tokyo Metropolitan Komagome Hospital
  • Yanagisawa Naoki
    Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital
  • Suganuma Akihiko
    Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital
  • Imamura Akifumi
    Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital
  • Ajisawa Atsushi
    Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital
  • Ando Minoru
    Department of Nephrology, Tokyo Metropolitan Komagome Hospital

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Other Title
  • 末期腎不全に至ったＨＩＶ患者１０症例の臨床的検討
  • マッキ ジンフゼン ニ イタッタ HIV カンジャ 10 ショウレイ ノ リンショウテキ ケントウ

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Abstract

As highly active antiretroviral therapy (HAART) has improved the longevity of human immunodeficiency virus (HIV) -infected patients, chronic kidney disease (CKD) and end-stage renal disease (ESRD) have emerged as significant comorbidities in such patients. This study investigated the clinical characteristics of HIV-infected patients who developed CKD, resulting in ESRD. Using electronic medical records, we retrospectively studied 10 ESRD patients with HIV-infection at Tokyo Metropolitan Komagome Hospital, in August 2009. Clinical characteristics, duration from HAART initiation to dialysis, parameters for HIV infection control, comorbidities and exposure to nephrotoxic drugs including antiretroviral drugs were studied. All individuals were Japanese males receiving HAART, and the mean patient age was 50.7±9.1 years. CD4+ T cell count and HIV RNA level at the initiation of dialysis were 340±185 cells/μL and less than 50 copies/mL, respectively. The serum creatinine level was 6.6±1.6 mg/dL and estimated glomerular filtration rate was 8.7±2.6 mL/min/1.73 m2. Mean period from the HAART initiation to ESRD was 8.1±2.9 years in overall patients. Patients who had preexisting CKD at the time of HAART initiation reached ESRD 4 years earlier than those who did not have preexisting CKD. Two patients died a few months and about 3 years after the initiation of dialysis, respectively. Before HAART initiation, the prevalence of diabetes, hypertension and hyperlipidemia was 50%, 30% and 10% among ESRD patients, respectively. Number of patients with hypertension and hyperlipidemia were 2-fold or more increased after HAART initiation. None of the patients showed exposure to tenofovir disoproxil fumarate, and 2 patients had exposure to indinavir. Exposure to other nephrotoxic drugs such as trimethoprim-sulfamethoxazole and nonsteroidal anti-inflammatory drugs were found in 4 and 3 patients, respectively. Half of the ESRD patients with HIV infection had diabetes before HAART initiation. The mean time to reach ESRD after HAART initiation was approximately 8 years. None of the ESRD patients had any exposure to Tenofovir disoproxil fumarate (TDF). Preexisting hypertension and metabolic diseases, and further deterioration of such comorbidities after the HAART initiation could be involved.

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