Hepatitis C and the risk of kidney disease and mortality in veterans with HIV.
Hepatitis C and the risk of kidney disease and mortality in veterans with HIV.
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DOI：
10.1097/qai.0b013e3181b980d4
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发表时间：
2010-02
期刊：
影响因子：
--
通讯作者：
VACS Project Team
中科院分区：
文献类型：
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作者：
Fischer MJ;Wyatt CM;Gordon K;Gibert CL;Brown ST;Rimland D;Rodriguez-Barradas MC;Justice AC;Parikh CR;VACS Project Team
目的：探讨丙型肝炎病毒(HCV)感染对退伍军人HIV感染者慢性肾脏病(CKD)患病率的影响，并评价其与死亡率的独立相关性。我们研究了1998至2004年间通过退伍军人医疗管理局接受护理的艾滋病毒感染患者的全国队列。CKD定义为估计的肾小球滤过率[EGFR(毫升/分钟/1.73m2)]和lt；60。泊松回归用于评估慢性肾脏病、丙型肝炎和死亡率之间的关系。在23,155名感染艾滋病毒的退伍军人中，12%患有慢性肾脏病。队列中40%的人同时感染丙型肝炎病毒，与单一感染者相比，合并感染者患慢性肾脏病的比例更高(14%比11%，P<；0.001)。在7.6年的中位随访期中，37%的受试者死亡，调整后的死亡率随着表皮生长因子受体水平的降低而逐渐增加(P<；0.001)。在所有水平的EGFR中，合并感染丙型肝炎病毒的受试者的调整死亡率持续较高(P<；0.001)。丙型肝炎病毒与死亡率增加独立相关(发病率比1.23，95%可信区间1.17-1.29)。慢性肾脏病在感染艾滋病毒的退伍军人中很普遍，并与显著较高的死亡率有关。与单一感染丙型肝炎病毒的退伍军人相比，合并感染丙型肝炎的退伍军人慢性肾脏病的发病率和死亡率明显更高。
To examine the effect of hepatitis C virus (HCV) on the prevalence of chronic kidney disease (CKD) among veterans with HIV and to evaluate independent associations of HCV and CKD with mortality. We studied a national cohort of HIV-infected patients receiving care through the Veterans Healthcare Administration from 1998 to 2004. CKD was defined as an estimated glomerular filtration rate [eGFR (mL/min/1.73 m2)] < 60. Poisson regression was used to assess relationships between CKD, HCV, and mortality. Among 23,155 HIV-infected veterans, 12% had CKD. Forty percent of the cohort was coinfected with HCV, and a higher proportion of coinfected subjects had CKD compared with monoinfected subjects (14% vs 11%, P < 0.001). During the median follow-up of 7.6 years, 37% of subjects died and a graduated increase in adjusted mortality rates occurred with lower levels of eGFR (P < 0.001). Adjusted mortality rates were consistently higher in HCV-coinfected subjects across all levels of eGFR (P < 0.001). HCV was independently associated with increased mortality (incidence rate ratio 1.23, 95% confidence interval 1.17–1.29). CKD is prevalent in HIV-infected veterans and associated with substantially higher mortality. Compared with their monoinfected counterparts, veterans coinfected with HCV have significantly higher rates of CKD and mortality.