biostudies-literatureEstrella MMNICHD NIH HHSNIDDK NIH HHSNCRR NIH HHSNIAID NIH HHS217-20https://www.ebi.ac.uk/biostudies/studies/S-EPMC3243740biostudies-literatureUnknown55(2)BACKGROUND:In the early highly active antiretroviral therapy (HAART) era, kidney dysfunction was strongly associated with death among HIV-infected individuals. We re-examined this association in the later HAART period to determine whether chronic kidney disease remains a predictor of death after HAART initiation. METHODS:To evaluate the effect of kidney function at the time of HAART initiation on time to all-cause mortality, we evaluated 1415 HIV-infected women initiating HAART in the Women's Interagency HIV Study. Multivariable proportional hazards models with survival times calculated from HAART initiation to death were constructed; participants were censored at the time of the last available visit or December 31, 2006. RESULTS:Chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m) at HAART initiation was associated with higher mortality risk adjusting for age, race, hepatitis C serostatus, AIDS history, and CD4 cell count (hazard ratio 2.23, 95% confidence interval: 1.45-3.43). Adjustment for hypertension and diabetes history attenuated this association (hazard ratio = 1.89, confidence interval: 0.94-3.80). Lower kidney function at HAART initiation was weakly associated with increased mortality risk in women with prior AIDS (hazard ratio = 1.09, confidence interval: 1.00-1.19, per 20% decrease in estimated glomerular filtration rate). CONCLUSIONS:Kidney function at HAART initiation remains an independent predictor of death in HIV-infected individuals, especially in those with a history of AIDS. Our study emphasizes the necessity of monitoring kidney function in this population. Additional studies are needed to determine mechanisms underlying the increased mortality risk associated with chronic kidney disease in HIV-infected persons.Journal of acquired immune deficiency syndromes (1999)The impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women.PMC3243740R01-DK-07677001U01 DK070657K23 DK081317-02U01-AI-42590U01 AI034994U01 AI035004U01 AI0349931R01-DK-072367R01 DK072367K23 DK081317U01-AI-31834UL1 RR024131R21 DK078218U01 AI031834U01 AI0349895U01DK070657-031K23-DK-081317-01A1U01 HD032632R01 DK080094U01-AI-34989,R01-DK-080094-02U01 AI042590R21-DK078218-01A1U01-HD-32632U01-AI-35004U01-AI-34993U01-AI-34994Estrella MMAbraham AMerenstein DJAnastos KAstor BCParekh RSDehovitz JACohen MHGange SJSzczech LAPearce CLTien PCfalseThe impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women.BACKGROUND:In the early highly active antiretroviral therapy (HAART) era, kidney dysfunction was strongly associated with death among HIV-infected individuals. We re-examined this association in the later HAART period to determine whether chronic kidney disease remains a predictor of death after HAART initiation. METHODS:To evaluate the effect of kidney function at the time of HAART initiation on time to all-cause mortality, we evaluated 1415 HIV-infected women initiating HAART in the Women's Interagency HIV Study. Multivariable proportional hazards models with survival times calculated from HAART initiation to death were constructed; participants were censored at the time of the last available visit or December 31, 2006. RESULTS:Chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m) at HAART initiation was associated with higher mortality risk adjusting for age, race, hepatitis C serostatus, AIDS history, and CD4 cell count (hazard ratio 2.23, 95% confidence interval: 1.45-3.43). Adjustment for hypertension and diabetes history attenuated this association (hazard ratio = 1.89, confidence interval: 0.94-3.80). Lower kidney function at HAART initiation was weakly associated with increased mortality risk in women with prior AIDS (hazard ratio = 1.09, confidence interval: 1.00-1.19, per 20% decrease in estimated glomerular filtration rate). CONCLUSIONS:Kidney function at HAART initiation remains an independent predictor of death in HIV-infected individuals, especially in those with a history of AIDS. Our study emphasizes the necessity of monitoring kidney function in this population. Additional studies are needed to determine mechanisms underlying the increased mortality risk associated with chronic kidney disease in HIV-infected persons.2010-01-01T00:00:00Z2010 Oct2020-11-01T08:39:45Z2019-03-27T00:47:14ZS-EPMC32437402058168810.1097/QAI.0b013e3181e674f410.1097/qai.0b013e3181e674f4