KIDNEY DISEASE IN HIV-POSITIVE PATIENTS

1. KIDNEY DISEASE IN HIV-POSITIVE PATIENTS

2. INTRODUCTION • HIV infection is associated with kidney disease : • HIV-associated nephropathy(HIVAN) • progressive kidney failure (associated with death in AIDS stage).

3. Objectives • Assessing the symptoms of kidney disease in HIV-positive persons that undergo antiviral treatment , monitored in “ClinicaBoliInfectioase I, Tg.Mures”, in 2010.

4. Methods • Statistical Analysis ( GraphPadInStat 3) • Retrospective study • Random sample • 40 patients

5. Methods • Glomerular Filtration Rate(GFR) • Proteinuria • Urinalysis • Kidney ecogarphy

6. The changes found where correlated with: • HIV-infection exposure period • immunodepression stage • types of Antiretroviral (ARV) drugs

7. Chronic kidney disease : • GFR <60ml/min/1.73sqr.m • > 3 months • using the Cockcroft-Gault formula(www.cphiv.dk/TOOLS/GFR/tabid/301/Default.aspx)

8. Results: • Average age: 22 years • Average age of HIV-infection exposure period: 15 years • exposure period to antiretroviral drugs: 9,5 years Kidney disease was found in 65% of the patients and was associated with the following changes: • decrease of the GFR • asymptomatic proteinuria • kidney lithiasis

9. Distribution of sample, depending on year of birth

10. Distribution of sample, depending on stage of HIV infection

11. Decrease of the GFR

12. Asymptomatic proteinuria

13. Kidney lithiasis

14. Kidney lithiasis is associated with : • Ureterohydronephrosis(8%) • Urinary tract infections(UTI) (37.5 %)

15. UTI associating CD4<200/cubic mm

16. UTI associating CD4<200 (Fisher’s test) • p=1 • Relative risk=0,93% • Conffidence interval95%=0,31-2,83

17. Distribution of bacteria in UTI

18. Antiretroviral therapy:

19. Conclusions: • 65%of the patients presented one or more changes of the kidney function: • asymptomatic proteinuria(17,5%) • kidney lithiasis(35,2%) • UTI(32%)

20. Conclusions: • There was no decrease of the GFR < 60 ml/min/1.73sqr.m • There was no association between CD4<200 and UTI

21. Conclusions: • Although chronicaly exposed to HIV infection and antiretroviral drugs, the patients included in this study did not show HIV-associated nephropathy( HIVAN) .

22. Bibliography: • http://www.cphiv.dk/TOOLS/GFR/tabid/301/Default.aspx -GFR Calculate • www.medscape.com/vewarticle/731174 -”Estimated GFR rate, Chronic • Kidney Disease and Antiretroviral Drug use in HIV-positive patients”(A Mocoft, O Kirk, P Reiss, S De Wit, D Sedlacek, M Beniowski, J Gattell, A N Phillips, B Lendergerber, JD Lundgren) • www.medscape.com/vewarticle/735313 -”Evaluation of GFR in HIV-1_infected Patients Before and After Combined Antiretroviral Therapy Exposure”( F Tordato, A CozziLepri, P Cicconi, A De Luca, A, Antinori,VColangeli, A Castagna, P Nasta, N Landisa, A Giacometti, A d”ArminioMonoforte) • Campbell LJ, Ibrahim F, Fisher M, Holt SG, Hendry BM, Post FA. Spectrum of chronic kidney disease HIV-infected patients, HIV Med 2009; • National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; • Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. www.aidsinfo.nih.gov; 2010;

23. Thank You for your attention!