Hepatitis C Seropositivity and Kidney Function Decline Among Women With HIV: Data From the Women's Interagency HIV Study

Tsui, Judith; Vittinghoff, Eric; Anastos, Kathryn; Augenbraun, Michael; Young, Mary; Nowicki, Marek; Cohen, Mardge H.; Peters, Marion G.; Golub, Elizabeth T.; Szczech, Lynda

doi:10.1053/j.ajkd.2009.02.009

« Previous Next »American Journal of Kidney Diseases
Volume 54, Issue 1 , Pages 43-50, July 2009

Hepatitis C Seropositivity and Kidney Function Decline Among Women With HIV: Data From the Women's Interagency HIV Study

Judith Tsui, MD, MPH
- Boston University School of Medicine, Boston, MA
- Address correspondence to Judith Tsui, MD, MPH, Boston University School of Medicine, 801 Massachusetts Ave, 2nd floor, Boston, MA 02118
Eric Vittinghoff, PhD
- University of California, San Francisco, CA
Kathryn Anastos, MD
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
Michael Augenbraun, MD
- SUNY Downstate, Brooklyn, NY
Mary Young, MD
- Georgetown University, Washington, DC
Marek Nowicki, PhD
- University of Southern California, Los Angeles, CA
Mardge H. Cohen, MD
- CORE Center, Cook County Bureau of Health Services and Rush University, Chicago, IL
Marion G. Peters, MD
- University of California, San Francisco, CA
Elizabeth T. Golub, PhD
- Johns Hopkins University, Baltimore, MD
Lynda Szczech, MD, MSCE
- Duke University, Raleigh-Durham, NC

Received 27 November 2008; accepted 14 January 2009. published online 27 April 2009.

Background

How coinfection with hepatitis C virus (HCV) impacts on the trajectory of kidney function in human immunodeficiency virus (HIV)-infected patients is unclear. This study examined the effect of HCV infection on kidney function over time in women infected with HIV.

Study Design

Retrospective observational cohort.

Setting & Participants

Study sample included participants from the Women's Interagency HIV Study who were HIV infected and had undergone HCV antibody testing and serum creatinine measurement at baseline.

Predictor

HCV seropositivity.

Outcomes & Measurement

Estimated glomerular filtration rate (eGFR) calculated from semi-annual serum creatinine measurements using the 4-variable Modification of Diet in Renal Diseases (MDRD) Study equation. Linear mixed models were used to evaluate the independent effect of HCV seropositivity on eGFR over time, adjusting for demographic factors, comorbid conditions, illicit drug use, measures of HIV disease status, use of medications, and interactions with baseline low eGFR (<60 mL/min/1.73 m²).

Results

Of 2,684 HIV-infected women, 952 (35%) were found to be HCV seropositive. In 180 women with chronic kidney disease (CKD) at baseline (eGFR < 60 mL/min/1.73 m²), HCV seropositivity was independently associated with a fully adjusted net decrease in eGFR of approximately 5% per year (95% confidence interval, 3.2 to 7.2) relative to women who were seronegative. In contrast, HCV infection was not independently associated with a decrease in eGFR in women without low eGFR at baseline (P < 0.001 for interaction).

Limitations

The MDRD Study equation has not been validated as a measure of GFR in persons with HIV or HCV infection. Proteinuria was not included in the study analysis. Because the study is observational, effects of residual confounding cannot be excluded.

Conclusions

In HIV-infected women with CKD, coinfection with HCV is associated with a modest, but statistically significant, decrease in eGFR over time. More careful monitoring of kidney function may be warranted for HIV-infected patients with CKD who are also coinfected with HCV.

Index Words: Hepatitis C virus, human immunodeficiency virus (HIV), kidney diseases, women