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Review
. 2022 Nov;23(10):1078-1084.
doi: 10.1111/hiv.13317. Epub 2022 Apr 26.

Prevalence, progression, and management of advanced chronic kidney disease in a cohort of people living with HIV

Anna Bonjoch  1 , Javier Juega  2 , Patricia Echeverría  1 , Jordi Puig  1 , Nuria Perez-Alvarez  1   3 , Jordi Bonal  2 , Cora Loste  1 , Bonaventura Clotet  1   4   5 , Eugènia Negredo  1   4
Affiliations
Free article
Review

Prevalence, progression, and management of advanced chronic kidney disease in a cohort of people living with HIV

Anna Bonjoch et al. HIV Med. 2022 Nov.
Free article

Abstract

Background: Advanced kidney disease is an emerging problem in people living with HIV despite sustained viral suppression.

Methods: We performed a prospective cohort study to identify people living with HIV with advanced kidney disease according to the Kidney Disease Improving Global Outcomes criteria and to assess disease progression over a 48-week period following the offer of targeted multidisciplinary management.

Results: From our cohort of 3090 individuals, 55 (1.8%, 95% confidence interval [CI] 1.31-2.25) fulfilled the inclusion criteria. Most were male (83.6%), and the median (interquartile range [IQR]) age was 58 (53.25-66.75) years. Nadir CD4 T-cell count was 135.5 (IQR 43.5-262.75) cells/μl, current CD4 T-cell count was 574 (IQR 438.5-816) cells/μl, and 96% had maintained HIV viral suppression. The most frequent comorbidity was arterial hypertension (85.5%). Inadequate antiretroviral dose was detected in three individuals (5.5%), and drug-drug interactions were recorded in eight (14.5%), mainly involving the use of cobicistat (n = 5 [9%]). Four individuals (7%) required modification of their concomitant treatment. Seven (13%) had to start or resume follow-up with a nephrologist. Nine participants (16.4%) experienced an improvement in kidney disease stage, three individuals (5.5%) underwent renal transplantation, and one (2%) started haemodialysis.

Conclusions: Our results show that a multidisciplinary approach, including a critical review of treatment and evaluation of specific requirements, could be useful for anticipating drug-drug interactions and toxicities and for reducing death and hospitalization in people living with HIV with advanced kidney disease.

Keywords: HIV; advanced chronic renal disease; haemodialysis; interactions; management; renal transplant.

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References

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