Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors

Abimereki Muzaale, Keri Althoff, C John Sperati, Alison Gump Abraham, L. M. Kucirka, Allan B Massie, M. M. Kitahata, M. A. Horberg, A. C. Justice, M. J. Fischer, M. J. Silverberg, A. A. Butt, S. L. Boswell, A. R. Rachlis, A. M. Mayor, M. J. Gill, J. J. Eron, S. Napravnik, D. R. Drozd, J. N. MartinR. J. Bosch, Christine Durand, J. E. Locke, Richard D Moore, Gregory M Lucas, Dorry Segev

Research output: Contribution to journalArticle

Abstract

New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load <400 copies/mL, and CD4+ count ≥500 cells/μL, the 9-year cumulative incidence of ESRD was higher than that of their HIV-negative peers, yet still low: 2.5 versus 1.1 per 10 000 among white women, 3.0 versus 1.3 per 10 000 among white men, 13.2 versus 3.6 per 10 000 among black women, and 15.8 versus 4.4 per 10 000 among black men. HIV-positive individuals with no comorbidities and well-controlled disease may be considered low-risk kidney donor candidates.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - 2017

Fingerprint

Chronic Kidney Failure
Tissue Donors
HIV
Kidney
Incidence
Acquired Immunodeficiency Syndrome
Health
CD4 Lymphocyte Count
North America
Viral Load
Coinfection
Hepacivirus
HIV Infections
Comorbidity
Research Design
Hypertension

Keywords

  • Clinical research/practice
  • Donors and donation: living
  • Infection and infectious agents
  • Infectious disease
  • Kidney transplantation/nephrology
  • Viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors. / Muzaale, Abimereki; Althoff, Keri; Sperati, C John; Abraham, Alison Gump; Kucirka, L. M.; Massie, Allan B; Kitahata, M. M.; Horberg, M. A.; Justice, A. C.; Fischer, M. J.; Silverberg, M. J.; Butt, A. A.; Boswell, S. L.; Rachlis, A. R.; Mayor, A. M.; Gill, M. J.; Eron, J. J.; Napravnik, S.; Drozd, D. R.; Martin, J. N.; Bosch, R. J.; Durand, Christine; Locke, J. E.; Moore, Richard D; Lucas, Gregory M; Segev, Dorry.

In: American Journal of Transplantation, 2017.

Research output: Contribution to journalArticle

Muzaale, A, Althoff, K, Sperati, CJ, Abraham, AG, Kucirka, LM, Massie, AB, Kitahata, MM, Horberg, MA, Justice, AC, Fischer, MJ, Silverberg, MJ, Butt, AA, Boswell, SL, Rachlis, AR, Mayor, AM, Gill, MJ, Eron, JJ, Napravnik, S, Drozd, DR, Martin, JN, Bosch, RJ, Durand, C, Locke, JE, Moore, RD, Lucas, GM & Segev, D 2017, 'Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors', American Journal of Transplantation. https://doi.org/10.1111/ajt.14235
Muzaale, Abimereki ; Althoff, Keri ; Sperati, C John ; Abraham, Alison Gump ; Kucirka, L. M. ; Massie, Allan B ; Kitahata, M. M. ; Horberg, M. A. ; Justice, A. C. ; Fischer, M. J. ; Silverberg, M. J. ; Butt, A. A. ; Boswell, S. L. ; Rachlis, A. R. ; Mayor, A. M. ; Gill, M. J. ; Eron, J. J. ; Napravnik, S. ; Drozd, D. R. ; Martin, J. N. ; Bosch, R. J. ; Durand, Christine ; Locke, J. E. ; Moore, Richard D ; Lucas, Gregory M ; Segev, Dorry. / Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors. In: American Journal of Transplantation. 2017.
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AU - Althoff, Keri

AU - Sperati, C John

AU - Abraham, Alison Gump

AU - Kucirka, L. M.

AU - Massie, Allan B

AU - Kitahata, M. M.

AU - Horberg, M. A.

AU - Justice, A. C.

AU - Fischer, M. J.

AU - Silverberg, M. J.

AU - Butt, A. A.

AU - Boswell, S. L.

AU - Rachlis, A. R.

AU - Mayor, A. M.

AU - Gill, M. J.

AU - Eron, J. J.

AU - Napravnik, S.

AU - Drozd, D. R.

AU - Martin, J. N.

AU - Bosch, R. J.

AU - Durand, Christine

AU - Locke, J. E.

AU - Moore, Richard D

AU - Lucas, Gregory M

AU - Segev, Dorry

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N2 - New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load <400 copies/mL, and CD4+ count ≥500 cells/μL, the 9-year cumulative incidence of ESRD was higher than that of their HIV-negative peers, yet still low: 2.5 versus 1.1 per 10 000 among white women, 3.0 versus 1.3 per 10 000 among white men, 13.2 versus 3.6 per 10 000 among black women, and 15.8 versus 4.4 per 10 000 among black men. HIV-positive individuals with no comorbidities and well-controlled disease may be considered low-risk kidney donor candidates.

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