Antiretroviral-treated HIV-infected women have similar long-term kidney function trajectories as HIV-uninfected women

Abstract

Natural history studies suggest increased risk for kidney function decline with HIV infection, but few studies have made comparisons with HIV-uninfected women. We examined whether HIV infection treated with highly active antiretroviral therapy (HAART) remains associated with faster kidney function decline in the Women's Interagency HIV Study. HIV-infected women initiating HAART with (n=105) or without (n=373) tenofovir (TDF) were matched to HIV-uninfected women on calendar and length of follow-up, age, systolic blood pressure, hepatitis C antibody serostatus, and diabetes history. Linear mixed models were used to evaluate differences in annual estimated glomerular filtration rate (eGFR). Person-visits were 4,741 and 11,512 for the TDF-treated and non-TDF-treated analyses, respectively. Mean baseline eGFRs were higher among women initiated on TDF-containing HAART and lower among those on TDF-sparing HAART compared to their respective HIV-uninfected matches (p<0.05 for both). HIV-infected women had annual rates of eGFR changes similar to HIV-uninfected matches (p-interaction >0.05 for both). Adjusting for baseline eGFR, mean eGFRs at 1 and 3 years of follow-up among women initiated on TDF-containing HAART were lower than their uninfected matches (-4.98 and -4.26 ml/min/1.73 m(2), respectively; p<0.05 for both). Mean eGFR of women initiated on TDF-sparing HAART was lower versus uninfected matches at 5 years (-2.19 ml/min/1.73 m(2), p=0.03). HAART-treated HIV-infected women had lower mean eGFRs at follow-up but experienced rates of annual eGFR decline similar to HIV-uninfected women. Tenofovir use in HIV-infected women with normal kidney function did not accelerate long-term kidney function decline relative to HIV-uninfected women.

FIG. 1.

Distribution of eGFR values during 5 years of follow-up among highly active antiretroviral therapy (HAART)-initiated HIV-infected women versus HIV-uninfected women. (A) The estimated glomerular filtration rate (eGFR) distribution among HIV-infected women initiated on tenofovir (TDF)-containing HAART versus matched HIV-uninfected women. (B) The eGFR distribution among HIV-infected women initiated on TDF-sparing HAART versus matched HIV-uninfected women. Open circles represent outliers.

FIG. 2.

Longitudinal kidney function among HAART-initiated HIV-infected women versus HIV-uninfected women. (A) The longitudinal kidney function among HIV-infected women initiated on TDF-containing HAART versus matched HIV-uninfected women. (B) The longitudinal kidney function among HIV-infected women initiated on TDF-sparing HAART versus matched HIV-uninfected women. The estimated glomerular filtration rate (GFR) for HIV-infected women is shown by the dashed line and for HIV-uninfected women is shown by the solid line.