Microalbuminuria and Kidney Disease Risk in HIV Patients Taking Combined Antiretroviral Therapy

Huylmer Lucena Chaves, Mayanna Pinho Batista, Adriana de Menezes Gomes, Amanda Antunes Costa, André Tigre Lima, Vinícius Diniz Arcelino do Ceará, Pedro Rubens Araújo Carvalho, Linna Albuquerque Sampaio, Fabrício de Maicy Bezerra, Melissa Soares Medeiros

Medicine School, Unichristus, Fortaleza, Brazil.

DOI: 10.4236/wja.2014.42029                

Abstract

Objectives: This study proposes to evaluate risk factors for kidney disease in HIV patients treated chronically and correlate with microalbuminuria measurements. Methods: Review charts and analyses of microalbuminuria in subgroup of HIV patients treated at Ceara/Brazil. Results: 149 patients, 69.1% male, mean 38.5 years old, infection mean 86.8 months. Mean Creatinine Clearance 110.2%, Creatinine 0.97, Urea 27.76 mg/dl, CD4+ 600.37 cels/mm³ and detectable viral load 530.59 copies with 61.7% undetectable. Mean Dosages of microalbuminuria/24h 147, 46 ± 820, 45 (N = 48) and microalbuminuria (mg/dl) 32.05 ± 85.25 (N = 43). Kidney Diseases Classification analyses evidenced 6.4% patients in stages ≥3 and 6.2% presented altered Microalbuminuria/24h. Patients using Tenofovir (TDF) 27.27% had Stage 2 and protease inhibitors (PI) had 4.1% in Stage 3. Proteinuria was observed in 5% stage ≥3. Association PI/TDF had 4.1% in Stage 3. No statistical difference between CD4 > or < 350 cels/mm³ and microalbuminuria/24h > 300 mg (p = 0.69); detectable/undetectable viral load and microalbuminuria/24h (p = 0.63) or stage ≥3 (p = 0.17); relation to Diabetes or arterial hypertension and microalbuminuria 24 h (p = 0.5 and p = 0.21); relation stage ≥3 and microalbuminuria/24h (p = 0.33); relation HIV diagnoses >/< 60 months and stage ≥3 (p = 0.51); or microalbuminuria/24h and TDF (p = 0.4), PI (p = 1), TDF/PI (p = 0.69), Atazanavir (p = 0.4) or Lopinavir/r (p = 1) regimens. There was statistical significance comparing age > or < 50 years and stage ≥3 (p = 0.001) without difference with age > or < 50 years and microalbuminuria/24h (p = 0.55) or microalbuminuria mg/d (p = 0.32). Relating comorbidities risk (Diabetes Mellitus plus Systemic Arterial Hypertension) to Kidney Diseases, it was found that 55.5% patients in Stage 3 or above with comorbidities compared with 15% with comorbidities in lower stages (P = 0.005). Nevertheless, comorbidities presence was not associated with microalbuminuria (p = 0.08). Conclusion: Kidney disease is a real risk for HIV patients and stages ≥3 have to be early detected. Microalbuminuria dosage did not demonstrate more sensibility than proteinuria to early diagnoses, even related to antiretroviral drugs. Major risk factor for kidney damage evidenced to be older than 50 years and there was no protective effect from CD4 or undetectable viral load.

Keywords

HIV, AIDS, Antiretroviral, Kidney Disease, Microalbuminuria

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Barre-Sinoussi, F. (2003) The Early Years of HIV Research: Integrating Clinical and Basic Research. Nature Medicine, 9, 844-846.
[2]	Attia, S., Egger, M., Muller, M., Zwahalen, M. and Low, N. (2009) Sexual Transmission of HIV According to Viral Load and Antiretroviral Therapy: Systematic Review and Meta-Analysis. AIDS, 23, 1397-404. http://dx.doi.org/10.1097/QAD.0b013e32832b7dca
[3]	ART-CC (2008) Antiretroviral Cohort Collaboration. Lancet, 372, 293-299.
[4]	Kline, E.R., Kleinhenz, D.J., Liang, B., Dikalov, S., Guidot, D.M., Hart, C.M., Jones, D.P. and Sutliff, R.L. (2008) Vascular Oxidative Stress and Nitric Oxide Depletion in HIV-1 Transgenic Rats Are Reversed by Glutathione Restoration. American Journal of Physiology. Heart and Circulatory Physiology, 294, 2792-2804. http://dx.doi.org/10.1152/ajpheart.91447.2007
[5]	Aboud, M., Elgalib, Z., Kulasegaram, R. and Peters, B. (2007) Insulin Resistance and HIV Infection: A Review. International Journal of Clinical Practice, 61, 463-472. http://dx.doi.org/10.1111/j.1742-1241.2006.01267.x
[6]	Jiang, J., Fu, W., Wang, X.H., Lin, P., Yao, Q. and Chen, C. (2010) HIV Gp120 Induces Endothelial Dysfunction in Tumour Necrosis Factor-a-Activated Porcine and Human Endothelial Cells. Cardiovascular Research, 87, 366-374. http://dx.doi.org/10.1093/cvr/cvq013
[7]	Szczech, L.A., Grunfeld, C., Scherzer, R., Canchola, J.A., Horst, C., Sidney, S., Wohl, D. and Shlipakb, M.G. (2007) Microalbuminuria in HIV Infection. AIDS, 21, 1003-1009. http://dx.doi.org/10.1097/QAD.0b013e3280d3587f
[8]	Msango, L., Downs, J.A., Kalluvya, S.E., Kideny, B.R., Kabangila, R., Johnson, Jr., W.D., Fitzgerald, D.W. and Pecka, R.N. (2011) Renal Dysfunction among HIV-Infected Patients Starting Antiretroviral Therapy. AIDS, 25, 1421-1425. http://dx.doi.org/10.1097/QAD.0b013e328348a4b1
[9]	Baekken, M., Os, I., Sandvik, L. and Oektedalen, O. (2008) Microalbuminuria Associated with Indicators of Inflammatory Activity in an HIV-Positive Population. Nephrology Dialysis Transplantation, 23, 3130-3137. http://dx.doi.org/10.1093/ndt/gfn236
[10]	Kim, P.S., Woods, C., Dutcher, L., Georgoff, P., Rosenberg, A., Mican, J.A.M., Kopp, J.B. and Smith, M.A. (2011) Increased Prevalence of Albuminuria in HIV-Infected Adults with Diabetes. Plos One, 6, 1-7.
[11]	Ryom, L., Mocroft, A., Kirk, O., Worm, S.W., Kamara, D.A., Reiss, P., Ross, M., Fux, C.A., Morlat, P., Moranne, O., Smith, C., Lundgren, J.D. and D:A:D Study Group (2013) Association between Antiretroviral Exposure and Renal Impairment among HIV-Positive Persons with Normal Baseline Renal Function: The D:A:D Study. The Journal of Infectious Diseases, 207, 1359-1369. http://dx.doi.org/10.1093/infdis/jit043
[12]	National Kidney Foundation (2002) K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. American Journal of Kidney Diseases, 39, S1-266.
[13]	Hadigan, C., Edwards, E., Rosenberg, A., Purdy, J.B., Fleischman, E., Howard, L., Mican, J.A. M., Sampath, K., Oyalowo, A., Johnson, A., Adler, A., Rehm, C., Smith, M., Lai, L. and Kopp, J.B. (2013) Microalbuminuria in HIV Disease. American Journal of Nephrology, 37,443-451. http://dx.doi.org/10.1159/000350384
[14]	Wyatt, C.M., Hoover, D.R., Shi, Q., Seaberg, E., Wei, C., Tien, P.C., Karim, R., Lazar, J., Young, M.A., Cohen, M.H., Klotman, P.E. and Anastos, K. (2010) Microalbuminuria Is Associated with All-Cause and AIDS Mortality in Women With HIV Infection. Journal of Acquired Immune Deficiency Syndromes, 55, 73-77. http://dx.doi.org/10.1097/QAI.0b013e3181cc1070
[15]	Szczech, L.A., Menezes, P., Quinlivan, E.B., Horst, C., Bartlett, J.A. and Svetkey, L.P. (2010) Microalbuminuria Predicts Overt Proteinuria among Patients with HIV Infection. HIV Medicine, 11, 419-426.