Author(s): Wyatt CM, Malvestutto C, Coca SG, Klotman PE, Parikh CR
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Abstract BACKGROUND: In the era of antiretroviral therapy, non-AIDS complications such as kidney disease are important contributors to morbidity and mortality. OBJECTIVE: To estimate the impact of hepatitis C coinfection on the risk of kidney disease in HIV patients. DESIGN AND METHODS: Two investigators identified English-language citations in MEDLINE and Web of Science from 1989 through 1 July 2007. References of selected articles were reviewed. Observational studies and clinical trials of HIV-related kidney disease and antiretroviral nephrotoxicity were eligible if they included at least 50 subjects and reported hepatitis C status. Data on study characteristics, population, and kidney disease outcomes were abstracted by two independent reviewers. RESULTS: After screening 2516 articles, 27 studies were eligible and 24 authors confirmed or provided data. Separate meta-analyses were performed for chronic kidney disease outcomes (n = 10), proteinuria (n = 4), acute renal failure (n = 2), and indinavir toxicity (n = 5). The pooled incidence of chronic kidney disease was higher in patients with hepatitis C coinfection [6.2 versus 4.0\%; relative risk 1.49, 95\% confidence interval (CI) 1.08-2.06]. In meta-regression, prevalence of black race and the proportion of patients with documented hepatitis C status were independently associated with the risk of chronic kidney disease. The relative risk associated with hepatitis C coinfection was significantly increased for proteinuria (1.15; 95\% CI 1.02-1.30) and acute renal failure (1.64; 95\% CI 1.21-2.23), with no significant statistical heterogeneity. The relative risk of indinavir toxicity was 1.59 (95\% CI 0.99-2.54) with hepatitis C coinfection. CONCLUSION: Hepatitis C coinfection is associated with a significant increase in the risk of HIV-related kidney disease.
This article was published in AIDS
and referenced in Journal of Clinical Toxicology