Epidemiology

Immunosuppression risk factor for acute renal failure in HIV

Last Updated: 2006-08-01 15:57:05 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In HIV-infected patients, immunosuppression is a strong predictor of acute renal failure, report clinicians from North Carolina in the July issue of the Journal of Acquired Immune Deficiency Syndromes.

Dr. Nora Franceschini of the University of North Carolina in Chapel Hill and colleagues estimated the effect of immunodeficiency, measured by CD4 cell count, on the incidence of acute renal failure in 705 HIV-infected patients.

Sixty-nine percent of study subjects were male and 61% were African American. The mean age of subjects was 40 years and the median CD4 count at baseline was 352 cells per microliter.

A total of 109 acute renal failure events occurred in 69 patients over the study period - from January 1, 2000 to December 31, 2002.

Dr. Franceschini and colleagues observed that decreasing CD4 cell counts were associated with an increased incidence of acute renal failure. A CD4 count lower than 200 cells per microliter, independent of antiretroviral drug exposure and other factors, "remained an important predictor" of a patient experiencing an episode of acute renal failure.

This relationship was observed in HCV-infected and HCV-uninfected patients, the authors say, "although incidence rates were consistently higher among HCV-infected patients especially at lower CD4 cell counts," they point out.

Acute renal failure, conclude Dr. Franceschini and colleagues, "should be considered a potentially important complication among HIV-infected patients with normal renal function and access to HAART."

Moreover, the observation that acute renal failure incidence rates were higher during the first years of antiretroviral therapy suggests that increased monitoring of patients for acute renal failure is indicated when treatment is initiated, the investigators say.

J Acquir Immune Defic Syndr 2006;42:368-372.