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 K. Chen, Matthew Foy, Gregory M. Lucas, Michelle M. Estrella, Mohamed G. Atta

Research output: Contribution to journalArticlepeer-review

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/mm3, respectively; P = 0.02) and median estimated glomerular filtration rate (53.5 vs 35.5 mL/min/ 1.73 m2, 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
Volume79
Issue number5
DOIs
StatePublished - 2018

Keywords

  • Chronic kidney disease
  • Classic focal segmental glomerulosclerosis
  • HIV-infected patients
  • Renal biopsy
  • Viral suppression

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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