Long-Term kidney function, proteinuria, and associated risks among HIV-infected and uninfected men

Background: Factors affecting kidney function and proteinuria among HIV-positive (HIV+) and HIV-negative (HIV-) persons need better characterization. Methods: We evaluated estimated glomerular filtration rate (EGFR, ml/min per 1.73 m 2) changes, proteinuria prevalence (a urine protein-To-creatinine ratio of ≥0.2 at two consecutive visits) and associated factors among HIV+ and HIV-men. Results: There were 917 HIV+ men receiving HAART, 159 HIV+ men not receiving HAART, and 1305 HIV-men seen from October 2003 to September 2014. Median annual EGFR change was-0.5,-0.8% for HIV+ and-0.3% for HIV-men (P < 0.001). Factors significantly (P < 0.05) associated with more than 3% annual EGFR decline were HAART receipt (but no specific antiretroviral drug), age more than 50, hypertension, diabetes, current smoking. Proteinuria existed in 14.9% of visit-pairs among HAART recipients, 5.8% among non-HAART recipients, and 1.9% among HIV-men, and was associated with subsequent annual more than 3% EGFR decline (odds ratio 1.80, P < 0.001). Proteinuria-Associated factors also included HAART use (vs. HIV-), age at least 50 (vs. <40), diabetes, hypertension, current smoking, hepatitis C virus-infection (all P < 0.05) and, among HIV+ men, lower CD4⁺ cell count, didanosine, saquinavir, or nelfinavir use (all P < 0.05). After adjusting for proteinuria, among HAART users, having a detectable HIV RNA, cumulative use of tenofovir disoproxil fumarate, emtricitabine, ritonavir, atazanavir, any protease inhibitor, or fluconazole were associated with more than 3% annual EGFR decline. Conclusion: Longitudinal kidney function decline was associated with HAART use but no individual antiretroviral drug, and traditional kidney disease risks. Proteinuria was nearly seven times more common in HAART-Treated men than HIV-men, reflected recent EGFR decline and predicted subsequent EGFR decline.