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. 2011;16(4):591-6.
doi: 10.3851/IMP1766.

Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy

Christina M Wyatt  1 , Donald R Hoover, Qiuhu Shi, Phyllis C Tien, Roksana Karim, Mardge H Cohen, Johanna L Goderre, Eric C Seaberg, Jason Lazar, Mary A Young, Paul E Klotman, Kathryn Anastos
Affiliations

Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy

Christina M Wyatt et al. Antivir Ther. 2011.

Abstract

Background: We previously reported an increased risk of all-cause and AIDS mortality among HIV-infected women with albuminuria (proteinuria or microalbuminuria) enrolled in the Women's Interagency HIV Study (WIHS) prior to the introduction of HAART.

Methods: The current analysis includes 1,073 WIHS participants who subsequently initiated HAART. Urinalysis for proteinuria and semi-quantitative testing for microalbuminuria from two consecutive study visits prior to HAART initiation were categorized as follows: confirmed proteinuria (both specimens positive for protein), confirmed microalbuminuria (both specimens positive with at least one microalbuminuria), unconfirmed albuminuria (one specimen positive for proteinuria or microalbuminuria), or negative (both specimens negative). Time from HAART initiation to death was modelled using proportional hazards analysis.

Results: Compared with the reference group of women with two negative specimens, the hazard ratio (HR) for all-cause mortality was significantly increased for women with confirmed microalbuminuria (HR 1.9, 95% CI 1.2-2.9). Confirmed microalbuminuria was also independently associated with AIDS death (HR 2.3, 95% CI 1.3-4.3), whereas women with confirmed proteinuria were at increased risk for non-AIDS death (HR 2.4, 95% CI 1.2-4.6).

Conclusions: In women initiating HAART, pre-existing microalbuminuria independently predicted increased AIDS mortality, whereas pre-existing proteinuria predicted increased risk of non-AIDS death. Urine testing may identify HIV-infected individuals at increased risk for mortality even after the initiation of HAART. Future studies should consider whether these widely available tests can identify individuals who would benefit from more aggressive management of HIV infection and comorbid conditions associated with mortality in this population.

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Conflict of interest statement

Disclosures: The authors have no potential conflicts of interest related to this work.

Figures

Figure 1
Figure 1
Kaplan-Meier estimates of time to all-cause (a), AIDS (b), and non-AIDS death (c).
See this image and copyright information in PMC

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