Association of HIV Suppression With Kidney Disease Progression Among HIV-Positive African Americans With Biopsy-Proven Classic FSGS.
Association of HIV Suppression With Kidney Disease Progression Among HIV-Positive African Americans With Biopsy-Proven Classic FSGS.
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HIV 阳性非裔美国人中 HIV 抑制与肾脏疾病进展的关联，经活检证实经典 FSGS。
DOI：
10.1097/qai.0000000000001860
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Atta,MohamedG
中科院分区：
文献类型：
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作者：
McMahon,BlaithinA;Hanouneh,Mohamad;Chedid,Alice;Fine,DerekM;Chen,TeresaK;Foy,Matthew;Lucas,GregoryM;Estrella,MichelleM;Atta,MohamedG
背景：在联合抗逆转录病毒治疗的时代，经典局灶节段性肾小球硬化（FSGS）是非洲裔美国人HIV阳性肾病患者最常见的组织病理学发现。我们试图确定HIV抑制是否与HIV阳性的非裔美国人活检证实的经典FSGS.Methods的进展为终末期肾病（ESRD）的风险较低：HIV阳性的非裔美国人谁在一个单一的三级医院接受肾活检1996年1月至2011年6月之间被证实为经典FSGS的节段性肾小球硬化症的存在下，没有功能的HIV相关性肾病。多变量考克斯比例风险模型被用来检查病毒抑制（HIV-RNA< 400拷贝每毫升活检）与时间进展到ESRD.Results的独立关联：在55例HIV阳性的非裔美国人与经典FSGS，26抑制病毒载量在活检时。与病毒血症患者相比，病毒抑制患者的平均CD 4+细胞计数（分别为452 vs. 260 cell/mm 3; P= 0.02）和估计的肾小球滤过率中位数（分别为53.5 vs. 35.5 mL/min/1.73 m2; P= 0.002）显著较高。校正性别和基线CD 4+细胞计数、估计肾小球滤过率和蛋白尿后，基线时HIV-RNA水平< 400拷贝/毫升的患者进展为ESRD的风险降低75（风险比= 0.25; 95% CI：0.07 - 0.88），中位随访时间为2.70年（四分位距：0.80-5.15岁）。在患有典型FSGS的HIV感染的非裔美国人中，HIV抑制与进展为ESRD的风险显著降低相关，支持联合抗逆转录病毒治疗在HIV阳性个体中对这种组织病理学以及HIV相关肾病的潜在作用。
Background:In the era of combined antiretroviral therapy, classic focal segmental glomerulosclerosis (FSGS) is the most common histopathological finding in African American HIV-positive patients with kidney disease. We sought to determine whether HIV suppression is associated with lower risk of progression to end-stage renal disease (ESRD) among HIV-positive African Americans with biopsy-confirmed classic FSGS.Methods:HIV-positive African Americans who underwent kidney biopsies at a single tertiary hospital between January 1996 and June 2011 were confirmed as having classic FSGS by the presence of segmental glomerulosclerosis without features of HIV-associated nephropathy. Multivariable Cox proportional hazards models were used to examine the independent association of viral suppression (HIV-RNA< 400 copies per milliliter at biopsy) with time to progression to ESRD.Results:Of the 55 HIV-positive African Americans with classic FSGS, 26 had suppressed viral loads at the time of biopsy. Compared to viremic patients, those who were virally suppressed had a significantly higher mean CD4+ cell count (452 vs. 260 cell/mm 3, respectively; P= 0.02) and median estimated glomerular filtration rate (53.5 vs 35.5 mL/min/1.73 m 2, respectively; P= 0.002). Adjusting for sex and baseline CD4+ cell count, estimated glomerular filtration rate, and proteinuria, those with HIV-RNA levels< 400 copies per milliliter at baseline had a 75% lower risk of progressing to ESRD (hazard ratio= 0.25; 95% CI: 0.07 to 0.88) during a median follow-up time of 2.70 years (interquartile range: 0.80–5.15 years).Conclusions:HIV suppression is associated with significantly lower risk of progression to ESRD among HIV-infected African Americans with classic FSGS, supporting the potential role of combined antiretroviral therapy for this histopathology in addition to HIV-associated nephropathy among HIV-positive individuals.