Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy

Christina M. Wyatt, Donald R. Hoover, Qiuhu Shi, Phyllis C. Tien, Roksana Karim, Mardge H. Cohen, Johanna L. Goderre, Eric Carl Seaberg, Jason Lazar, Mary A. Young, Paul E. Klotman, Kathryn Anastos

Research output: Contribution to journalArticle

Abstract

Background: We previously reported an increased risk of all-cause and AIDS mortality among HIV-infected women with albuminuria (proteinuria or microalbuminuria) enrolled in the Women's Interagency HIV Study (WIHS) prior to the introduction of HAART. Methods: The current analysis includes 1,073 WIHS participants who subsequently initiated HAART. Urinalysis for proteinuria and semi-quantitative testing for microalbuminuria from two consecutive study visits prior to HAART initiation were categorized as follows: confirmed proteinuria (both specimens positive for protein), confirmed microalbuminuria (both specimens positive with at least one microalbuminuria), unconfirmed albuminuria (one specimen positive for proteinuria or microalbuminuria), or negative (both specimens negative). Time from HAART initiation to death was modelled using proportional hazards analysis. Results: Compared with the reference group of women with two negative specimens, the hazard ratio (HR) for all-cause mortality was significantly increased for women with confirmed microalbuminuria (HR 1.9, 95% CI 1.2-2.9). Confirmed microalbuminuria was also independently associated with AIDS death (HR 2.3, 95% CI 1.3-4.3), whereas women with confirmed proteinuria were at increased risk for non-AIDS death (HR 2.4, 95% CI 1.2-4.6). Conclusions: In women initiating HAART, pre-existing microalbuminuria independently predicted increased AIDS mortality, whereas pre-existing proteinuria predicted increased risk of non-AIDS death. Urine testing may identify HIV-infected individuals at increased risk for mortality even after the initiation of HAART. Future studies should consider whether these widely available tests can identify individuals who would benefit from more aggressive management of HIV infection and comorbid conditions associated with mortality in this population.

Original languageEnglish (US)
Pages (from-to)591-596
Number of pages6
JournalAntiviral Therapy
Volume16
Issue number4
DOIs
StatePublished - 2011

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Albuminuria
Highly Active Antiretroviral Therapy
Proteinuria
Acquired Immunodeficiency Syndrome
Mortality
HIV
Therapeutics
Urinalysis
HIV Infections
Urine
Population

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Wyatt, C. M., Hoover, D. R., Shi, Q., Tien, P. C., Karim, R., Cohen, M. H., ... Anastos, K. (2011). Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy. Antiviral Therapy, 16(4), 591-596. https://doi.org/10.3851/IMP1766

Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy. / Wyatt, Christina M.; Hoover, Donald R.; Shi, Qiuhu; Tien, Phyllis C.; Karim, Roksana; Cohen, Mardge H.; Goderre, Johanna L.; Seaberg, Eric Carl; Lazar, Jason; Young, Mary A.; Klotman, Paul E.; Anastos, Kathryn.

In: Antiviral Therapy, Vol. 16, No. 4, 2011, p. 591-596.

Research output: Contribution to journalArticle

Wyatt, CM, Hoover, DR, Shi, Q, Tien, PC, Karim, R, Cohen, MH, Goderre, JL, Seaberg, EC, Lazar, J, Young, MA, Klotman, PE & Anastos, K 2011, 'Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy', Antiviral Therapy, vol. 16, no. 4, pp. 591-596. https://doi.org/10.3851/IMP1766
Wyatt, Christina M. ; Hoover, Donald R. ; Shi, Qiuhu ; Tien, Phyllis C. ; Karim, Roksana ; Cohen, Mardge H. ; Goderre, Johanna L. ; Seaberg, Eric Carl ; Lazar, Jason ; Young, Mary A. ; Klotman, Paul E. ; Anastos, Kathryn. / Pre-existing albuminuria predicts AIDS and non-AIDS mortality in women initiating antiretroviral therapy. In: Antiviral Therapy. 2011 ; Vol. 16, No. 4. pp. 591-596.
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abstract = "Background: We previously reported an increased risk of all-cause and AIDS mortality among HIV-infected women with albuminuria (proteinuria or microalbuminuria) enrolled in the Women's Interagency HIV Study (WIHS) prior to the introduction of HAART. Methods: The current analysis includes 1,073 WIHS participants who subsequently initiated HAART. Urinalysis for proteinuria and semi-quantitative testing for microalbuminuria from two consecutive study visits prior to HAART initiation were categorized as follows: confirmed proteinuria (both specimens positive for protein), confirmed microalbuminuria (both specimens positive with at least one microalbuminuria), unconfirmed albuminuria (one specimen positive for proteinuria or microalbuminuria), or negative (both specimens negative). Time from HAART initiation to death was modelled using proportional hazards analysis. Results: Compared with the reference group of women with two negative specimens, the hazard ratio (HR) for all-cause mortality was significantly increased for women with confirmed microalbuminuria (HR 1.9, 95{\%} CI 1.2-2.9). Confirmed microalbuminuria was also independently associated with AIDS death (HR 2.3, 95{\%} CI 1.3-4.3), whereas women with confirmed proteinuria were at increased risk for non-AIDS death (HR 2.4, 95{\%} CI 1.2-4.6). Conclusions: In women initiating HAART, pre-existing microalbuminuria independently predicted increased AIDS mortality, whereas pre-existing proteinuria predicted increased risk of non-AIDS death. Urine testing may identify HIV-infected individuals at increased risk for mortality even after the initiation of HAART. Future studies should consider whether these widely available tests can identify individuals who would benefit from more aggressive management of HIV infection and comorbid conditions associated with mortality in this population.",
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AU - Wyatt, Christina M.

AU - Hoover, Donald R.

AU - Shi, Qiuhu

AU - Tien, Phyllis C.

AU - Karim, Roksana

AU - Cohen, Mardge H.

AU - Goderre, Johanna L.

AU - Seaberg, Eric Carl

AU - Lazar, Jason

AU - Young, Mary A.

AU - Klotman, Paul E.

AU - Anastos, Kathryn

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N2 - Background: We previously reported an increased risk of all-cause and AIDS mortality among HIV-infected women with albuminuria (proteinuria or microalbuminuria) enrolled in the Women's Interagency HIV Study (WIHS) prior to the introduction of HAART. Methods: The current analysis includes 1,073 WIHS participants who subsequently initiated HAART. Urinalysis for proteinuria and semi-quantitative testing for microalbuminuria from two consecutive study visits prior to HAART initiation were categorized as follows: confirmed proteinuria (both specimens positive for protein), confirmed microalbuminuria (both specimens positive with at least one microalbuminuria), unconfirmed albuminuria (one specimen positive for proteinuria or microalbuminuria), or negative (both specimens negative). Time from HAART initiation to death was modelled using proportional hazards analysis. Results: Compared with the reference group of women with two negative specimens, the hazard ratio (HR) for all-cause mortality was significantly increased for women with confirmed microalbuminuria (HR 1.9, 95% CI 1.2-2.9). Confirmed microalbuminuria was also independently associated with AIDS death (HR 2.3, 95% CI 1.3-4.3), whereas women with confirmed proteinuria were at increased risk for non-AIDS death (HR 2.4, 95% CI 1.2-4.6). Conclusions: In women initiating HAART, pre-existing microalbuminuria independently predicted increased AIDS mortality, whereas pre-existing proteinuria predicted increased risk of non-AIDS death. Urine testing may identify HIV-infected individuals at increased risk for mortality even after the initiation of HAART. Future studies should consider whether these widely available tests can identify individuals who would benefit from more aggressive management of HIV infection and comorbid conditions associated with mortality in this population.

AB - Background: We previously reported an increased risk of all-cause and AIDS mortality among HIV-infected women with albuminuria (proteinuria or microalbuminuria) enrolled in the Women's Interagency HIV Study (WIHS) prior to the introduction of HAART. Methods: The current analysis includes 1,073 WIHS participants who subsequently initiated HAART. Urinalysis for proteinuria and semi-quantitative testing for microalbuminuria from two consecutive study visits prior to HAART initiation were categorized as follows: confirmed proteinuria (both specimens positive for protein), confirmed microalbuminuria (both specimens positive with at least one microalbuminuria), unconfirmed albuminuria (one specimen positive for proteinuria or microalbuminuria), or negative (both specimens negative). Time from HAART initiation to death was modelled using proportional hazards analysis. Results: Compared with the reference group of women with two negative specimens, the hazard ratio (HR) for all-cause mortality was significantly increased for women with confirmed microalbuminuria (HR 1.9, 95% CI 1.2-2.9). Confirmed microalbuminuria was also independently associated with AIDS death (HR 2.3, 95% CI 1.3-4.3), whereas women with confirmed proteinuria were at increased risk for non-AIDS death (HR 2.4, 95% CI 1.2-4.6). Conclusions: In women initiating HAART, pre-existing microalbuminuria independently predicted increased AIDS mortality, whereas pre-existing proteinuria predicted increased risk of non-AIDS death. Urine testing may identify HIV-infected individuals at increased risk for mortality even after the initiation of HAART. Future studies should consider whether these widely available tests can identify individuals who would benefit from more aggressive management of HIV infection and comorbid conditions associated with mortality in this population.

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