IHospital Fêmina, Controle e Prevenção do Departamento de Infecção, Porto Alegre, RS, Brazil
IIUniversidade Federal de Ciências da Saúde de Porto Alegre, Curso de Pós Graduação em Hepatologia, Porto Alegre, RS, Brazil
IIIPontifícia Universidade Católica do Rio Grande do Sul, Programa de Graduação de Medicina e Ciências da Saúde, Porto Alegre, RS, Brazil
IVMayo Clinic School of Drugs, Division of Nephrology and Hypertension, Rochester, MN, USA
IIUniversidade Federal de Ciências da Saúde de Porto Alegre, Curso de Pós Graduação em Hepatologia, Porto Alegre, RS, Brazil
IIIPontifícia Universidade Católica do Rio Grande do Sul, Programa de Graduação de Medicina e Ciências da Saúde, Porto Alegre, RS, Brazil
Antonello VS, Antonello IC, Herrmann S and Tovo CV participated within the revision of the manuscript. Antonello VS, Antonello IC and Tovo CV participated within the design of the research and the drafting and revision of the manuscript. Antonello VS evaluated the medical information of the case and management sufferers. Antonello VS conceived the research and took part in each research design and coordination, and manuscript draft. The entire authors learn and authorized the ultimate model of the manuscript.
Summary
INTRODUCTION
HIV-related renal ailments are one of many main causes of persistent kidney ailments (CKDs) worldwide. Specifically, the brand new period of extremely energetic antiretroviral remedy (HAART) and early HIV analysis has improved survival and illness development, resulting in the next proportion of sufferers with renal abnormalities over time 1-3.
CKD is outlined by a sustained change in urinary sediment, such because the presence of proteinuria, or by a decreased glomerular filtration fee (GFR). Proteinuria is commonly the earliest manifestation of CKD and is extra widespread in HIV-infected people than in equally aged HIV-negative controls 1,4,5. Danger components for incident or progressive CKD in HIV-positive adults embody apolipoprotein-1 genetic polymorphism 4, hepatitis C virus (HCV) coinfection 5, a low CD4 T-cell depend, a excessive HIV viral load and conventional CKD threat components comparable to diabetes and hypertension 6.
The current research aimed to research the prevalence of pathological proteinuria and its threat components amongst HIV sufferers from a public HIV/AIDS reference clinic in Porto Alegre, Brazil.
MATERIALS AND METHODS
The current analysis was a cross-sectional research of HIV-infected sufferers who attended a public HIV/AIDS clinic in Porto Alegre, Brazil. The information have been collected from the information of sufferers who attended between March 2008 and December 2012. The research inhabitants included HIV sufferers aged 18 years or older who have been from the town of Porto Alegre and surrounding metropolitan area. All members had free entry to well being care and drugs, consistent with the nationwide well being program. Instances have been excluded if information weren’t accessible for evaluation.
Knowledge collected from information included age, gender, ethnicity, physique mass index (BMI), smoking historical past, use of illicit medicine and alcohol, earlier analysis of hypertension, diabetes mellitus, persistent hepatitis B an infection, persistent HCV an infection, lipid ranges, glucose ranges, urinalysis outcomes, arterial hypertension, medicine getting used, present CD4 depend (cells/mm3), present plasma HIV RNA degree (viral load), absence (naïve) or use of HAART and kind of HAART below use.
Urine samples have been analyzed by the Division of Laboratory Drugs on the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil and the analysis of proteinuria was made primarily based on the urinary protein-to-creatinine ratio (PCR) in a single-spot urine evaluation 3. Overt proteinuria was outlined as a PCR higher than 150 mg/g in response to Kidney Illness: Bettering World Outcomes (KDIGO) 7.
Blood strain was decided primarily based on a median of two measurements utilizing a calibrated automated machine, with every participant sitting in a relaxed, upright place. Hypertension was outlined in response to customary definitions set out within the Eighth Joint Nationwide Committee tips 8. Sufferers receiving an antihypertensive remedy, no matter blood strain, have been additionally outlined as hypertensive 8. The factors for the definitions of diabetes and dyslipidemia adopted ADA 9 and AACE 10 tips.
Statistical analyses included descriptive statistics with numbers (proportions) for categorical variables and means (± customary deviation) for steady variables. Categorical variables have been assessed utilizing the chi-square take a look at or Fisher’s precise take a look at and quantitative variables have been in contrast utilizing Scholar’s t-test. Adjusted residual evaluation was carried out to detect classes with a two-tailed (increased or decrease) anticipated frequency.
Vital variables with p<0.20 within the univariate evaluation have been additional analyzed utilizing a Poisson regression mannequin with strong variance. Fosamprenavir plus ritonavir (FPV/r) remedy was not included on this mannequin on account of its use by solely a small variety of sufferers. A price of p<0.05 was thought of statistically important. All statistical analyses have been carried out utilizing the SPSS software program, model 18 (IBM, Armonk, NY, USA).
RESULTS
DISCUSSION – “protein in urine hiv”
Proteinuria is a part of the definition of CKD and is a threat marker for development to end-stage renal illness (ESRD). HIV-associated nephropathy (HIVAN)-related threat components, together with an elevated HIV RNA degree, a low absolute CD4 lymphocyte depend, apolipoprotein-1 genetic polymorphism and hepatitis C and hepatitis B coinfection, are related to proteinuria 2. The current research detected a excessive prevalence of pathological proteinuria (20%) amongst HIV-infected people, just like different research within the literature, which have reported prevalence values starting from 17% to 32% 1,11.
This research examined the components related to proteinuria inside a big cohort of HIV-infected sufferers. Proteinuria was particularly related to an elevated HIV RNA degree and a CD4 lymphocyte depend under 200 cells/mm3. These findings are in step with prior research, by which threat components for incident or progressive CKD in HIV-positive adults included HIV illness severity 1,7,. Nonetheless, components historically related to CKD which were described within the literature, comparable to age, heart problems 1,4, diabetes, hypertension, weight problems 6,12 and HCV 13, weren’t linked to pathological proteinuria amongst HIV-positive people within the present research after multivariate evaluation.
The connection between antiretrovirals and pathological proteinuria was additionally examined and tenofovir-based remedy was considerably related to this situation within the multivariate evaluation. Many of the people on this group who offered with pathological proteinuria didn’t have albuminuria detected by dipstick (79.25%), suggesting proteinuria of tubular origin. Thus, these sufferers wouldn’t have benefited from utilizing angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In the meantime, FPV/r remedy confirmed an inclination towards affiliation with pathological proteinuria. Nonetheless, as a result of small variety of sufferers, fosamprenavir was not included within the multivariate evaluation. All different antiretrovirals weren’t linked to pathological proteinuria.
Sufferers with HIV an infection are susceptible to creating nephrotoxicity in response to antiretrovirals. The truth is, tenofovir and boosted protease inhibitors have been related to a decline within the GFR 14,15. Tenofovir is particularly a nucleoside reverse transcriptase inhibitor that may trigger acute kidney harm (AKI), proximal tubular dysfunction, or each together. The danger of kidney toxicity with tenofovir has various throughout completely different research, with estimates starting from 2% to 10% 15,16.
The advantages of antiretrovirals regarding proteinuria could also be much less substantial with regimens containing tenofovir in contrast with the choice, specifically, nucleoside reverse transcriptase inhibitors 17. Though a kidney biopsy will not be essential to diagnose tenofovir toxicity, it may be helpful in circumstances the place the analysis is much less clear or the place there are compelling causes to not discontinue tenofovir 18. As well as, within the setting of renal illness, a routine containing a boosted protease inhibitor (comparable to FPV/r) together with tenofovir has been related to a lower within the GFR 14, 19.
The current research has sure limitations. For instance, a number of of our findings might have been underestimated, on condition that the durations of HIV illness and HAART weren’t evaluated. Moreover, our analyses have been primarily based on a cross-sectional research; therefore, the temporality between components and the event of pathological proteinuria couldn’t be established. It was additionally tough to estimate the variety of sufferers with CKD as a result of small proportion of sufferers with irregular serum creatinine.
Conversely, our research possessed sure strengths as properly. Specifically, this research was performed in a inhabitants of HIV-infected individuals with medical follow-up and dependable data regarding antiretroviral use. The group studied was consultant for 2 causes: a big cohort of sufferers was evaluated and the profile of the sufferers inside the group is just like that of sufferers at the moment attending HIV clinics.
In conclusion, the danger of CKD on this massive modern cohort of HIV-infected people seemed to be attributable to a mix of HIV-related threat components. Along with the normal threat components cited within the literature, each regimens containing tenofovir and HIV illness severity appear to be crucial components related to CKD in sufferers with HIV.
Evaluation of proteinuria constitutes a novel technique for CKD staging in HIV-infected people and could also be successfully used to stratify the danger of development to ESRD. Given the rising incidence of HIV-related renal ailments as a reason for ESRD and the elevated mortality threat that ESRD imparts, additional investigation of methods to forestall or deal with the renal issues of HIV an infection is crucial.
ACKNOWLEDGMENTS
Footnotes
“protein in urine hiv”