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Improved HIV therapies decreased risk for ESRD
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Improvements in HIV treatment have resulted in a decreased risk for end-stage renal disease in infected adults, particularly among blacks, according to recent study results.
Racial disparities in the risks for developing end-stage renal disease (ESRD), however, still persist, researchers said.
Alison G. Abraham, MD, of Johns Hopkins Bloomberg School of Public Health, and colleagues assessed the impact of several clinical and demographic factors on the incidence of ESRD in HIV-infected adults from 2000 to 2009. Data extracted from the North American AIDS Cohort Collaboration for Research and Design validated 286 ESRD cases involving dialysis lasting longer than 6 months or renal transplantation. Analysis included 38,354 adults, aged 18 to 80 years, with HIV. The researchers used age- and sex-standardized incidence ratios (SIR) to estimate the likelihood of ESRD by race and Poisson regression analysis to identify predictors of ESRD.
More ESRD cases among HIV-infected adults occurred in black patients, with an average SIR of 4.5 (95% CI, 3.9-5.2), compared with an overall SIR of 3.2 (95% CI, 2.8-3.6). During the study period, blacks experienced a decline in ESRD from 532 to 303 for every 100,000 person-years; among nonblacks a decline from 138 to 34 per 100,000 person-years was observed. The decline in ESRD risk was coincident with increases in the prevalence of viral suppression. The researchers also observed an increase in ESRD risk from comorbid conditions, including diabetes mellitus, hypertension and HCV infection, which may have supplanted the risks for kidney disease from HIV infection.
Racial disparities in ESRD risk still persisted, however, with blacks experiencing an approximately sixfold increased risk for ESRD vs. whites. This is likely due to lower ART utilization and delayed entry into care among black patients, according to the researchers. Even given similar rates of viral suppression, blacks would likely still be at greater ESRD risk than whites because of genetic susceptibility to more aggressive chronic kidney disease progression, they said.
“These racial differences in ESRD risk have important implications,” the researchers wrote. “They highlight the need for continued efforts to close racial gaps in early access to antiretroviral therapy to achieve durable viral suppression as well as early interventional strategies for comorbid risk factors to slow kidney disease progression in HIV-infected black individuals.”
Disclosure: See the study for a full list of relevant financial disclosures.
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