Original Investigation
Pathogenesis and Treatment of Kidney Disease
Hepatitis C Seropositivity and Kidney Function Decline Among Women With HIV: Data From the Women's Interagency HIV Study

https://doi.org/10.1053/j.ajkd.2009.02.009Get rights and content

Background

How coinfection with hepatitis C virus (HCV) impacts on the trajectory of kidney function in human immunodeficiency virus (HIV)-infected patients is unclear. This study examined the effect of HCV infection on kidney function over time in women infected with HIV.

Study Design

Retrospective observational cohort.

Setting & Participants

Study sample included participants from the Women's Interagency HIV Study who were HIV infected and had undergone HCV antibody testing and serum creatinine measurement at baseline.

Predictor

HCV seropositivity.

Outcomes & Measurement

Estimated glomerular filtration rate (eGFR) calculated from semi-annual serum creatinine measurements using the 4-variable Modification of Diet in Renal Diseases (MDRD) Study equation. Linear mixed models were used to evaluate the independent effect of HCV seropositivity on eGFR over time, adjusting for demographic factors, comorbid conditions, illicit drug use, measures of HIV disease status, use of medications, and interactions with baseline low eGFR (<60 mL/min/1.73 m2).

Results

Of 2,684 HIV-infected women, 952 (35%) were found to be HCV seropositive. In 180 women with chronic kidney disease (CKD) at baseline (eGFR < 60 mL/min/1.73 m2), HCV seropositivity was independently associated with a fully adjusted net decrease in eGFR of approximately 5% per year (95% confidence interval, 3.2 to 7.2) relative to women who were seronegative. In contrast, HCV infection was not independently associated with a decrease in eGFR in women without low eGFR at baseline (P < 0.001 for interaction).

Limitations

The MDRD Study equation has not been validated as a measure of GFR in persons with HIV or HCV infection. Proteinuria was not included in the study analysis. Because the study is observational, effects of residual confounding cannot be excluded.

Conclusions

In HIV-infected women with CKD, coinfection with HCV is associated with a modest, but statistically significant, decrease in eGFR over time. More careful monitoring of kidney function may be warranted for HIV-infected patients with CKD who are also coinfected with HCV.

Section snippets

Study Participants

Women in this study were participants in the Women's Interagency HIV Study (WIHS), a multicenter prospective cohort study of the natural history, including treatment, of HIV infection. Full details of recruitment and baseline cohort characteristics have been described previously.9, 10 The WIHS enrolled women who were either infected with HIV (Western blot confirmed) or at risk of HIV infection between October 1994 and November 1995 and again between October 2001 and September 2002 from 6

Results

Of 2,791 HIV-positive women in WIHS, 2,702 (97%) had HCV serological results (Fig 1). Of those 2,702 women, 18 (0.7%) were missing baseline serum creatinine measurement and were excluded from the analysis, leaving a final study population of 2,684 women. Women who were missing HCV serological or baseline serum creatinine results (n = 107; 3.8% of the original 2,791) were slightly older (mean age, 37 ± 8 [SD] versus 35 ± 8 years; P = 0.008) and more likely to use injection drugs (47% versus 33%;

Discussion

In this study of HIV-infected women, HCV seropositivity was associated with a slightly lower eGFR over time in women who had eGFR less than 60 mL/min/1.73 m2 at baseline. In contrast, it did not appear to be associated with a lower eGFR over time in women with baseline eGFR of 60 mL/min/1.73 m2 or greater. The association between HCV seropositivity and decrease in renal function was statistically significant even after adjusting for demographic factors, illicit drug use, diabetes, hypertension,

Acknowledgements

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Support: WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-A1-34989, UO1-AI-34993, and UO1-AI-42590) and the National Institute of Child Health and Human Development (UO1-HD-32632). The study is cofunded by the National Cancer Institute, National Institute on

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    Originally published online as doi: 10.1053/j.ajkd.2009.02.009 on April 27, 2009.

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