Association of HIV Suppression With Kidney Disease Progression Among HIV-Positive African Americans With Biopsy-Proven Classic FSGS

Blaithin A. McMahon, Mohamad Hanouneh, Alice Chedid, Derek M Fine, Teresa Chen, Matthew Foy, Gregory M Lucas, Michelle M. Estrella, Mohamed Atta

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In the era of combined antiretroviral therapy, classic focal segmental glomerulosclerosis (FSGS) is the most common histopathological finding in African American HIV-positive patients with kidney disease. We sought to determine whether HIV suppression is associated with lower risk of progression to end-stage renal disease (ESRD) among HIV-positive African Americans with biopsy-confirmed classic FSGS. METHODS: HIV-positive African Americans who underwent kidney biopsies at a single tertiary hospital between January 1996 and June 2011 were confirmed as having classic FSGS by the presence of segmental glomerulosclerosis without features of HIV-associated nephropathy. Multivariable Cox proportional hazards models were used to examine the independent association of viral suppression (HIV-RNA < 400 copies per milliliter at biopsy) with time to progression to ESRD. RESULTS: Of the 55 HIV-positive African Americans with classic FSGS, 26 had suppressed viral loads at the time of biopsy. Compared to viremic patients, those who were virally suppressed had a significantly higher mean CD4 cell count (452 vs. 260 cell/mm, respectively; P = 0.02) and median estimated glomerular filtration rate (53.5 vs 35.5 mL/min/1.73 m, respectively; P = 0.002). Adjusting for sex and baseline CD4 cell count, estimated glomerular filtration rate, and proteinuria, those with HIV-RNA levels <400 copies per milliliter at baseline had a 75% lower risk of progressing to ESRD (hazard ratio = 0.25; 95% CI: 0.07 to 0.88) during a median follow-up time of 2.70 years (interquartile range: 0.80-5.15 years). CONCLUSIONS: HIV suppression is associated with significantly lower risk of progression to ESRD among HIV-infected African Americans with classic FSGS, supporting the potential role of combined antiretroviral therapy for this histopathology in addition to HIV-associated nephropathy among HIV-positive individuals.

Original languageEnglish (US)
Pages (from-to)639-643
Number of pages5
JournalJournal of acquired immune deficiency syndromes (1999)
Volume79
Issue number5
DOIs
StatePublished - Dec 15 2018

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Focal Segmental Glomerulosclerosis
Kidney Diseases
African Americans
Disease Progression
HIV
Biopsy
Chronic Kidney Failure
AIDS-Associated Nephropathy
CD4 Lymphocyte Count
Glomerular Filtration Rate
RNA
Viral Load
Proteinuria
Proportional Hazards Models
Tertiary Care Centers
Kidney

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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Association of HIV Suppression With Kidney Disease Progression Among HIV-Positive African Americans With Biopsy-Proven Classic FSGS. / McMahon, Blaithin A.; Hanouneh, Mohamad; Chedid, Alice; Fine, Derek M; Chen, Teresa; Foy, Matthew; Lucas, Gregory M; Estrella, Michelle M.; Atta, Mohamed.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 79, No. 5, 15.12.2018, p. 639-643.

Research output: Contribution to journalArticle

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AU - Fine, Derek M

AU - Chen, Teresa

AU - Foy, Matthew

AU - Lucas, Gregory M

AU - Estrella, Michelle M.

AU - Atta, Mohamed

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