12th Annual Conference of the British HIV Association 29 March–1 April 2006, Brighton, UK

THE EPIDEMIOLOGY OF HIV-ASSOCIATED NEPHROPATHY (HIVAN): THE LONDON HIV-NEPHROPATHY STUDY COHORT

HIV Med 2006; 7(Suppl. 1):4 (abstract no. O13)

Frank Post¹, Lucy Campbell¹, Paul Donohoe¹, Raj Thuraisingham², Guy Baily², Lisa Collins³, Anthi Balitsari³, Nick Larbalestier³, Rachel Hilton³, Derek Macallan⁴, Debu Banerjee⁴, Rachael Jones⁵, Brian Gazzard⁵, John Connolly⁶, Simon Edwards⁶, Sanjay Bhagani⁷, John Walsh¹ and Philippa Easterbrook^1
1 King’s College London, ² Royal London Hospital, ³ Guy’s and St Thomas’ Hospital, ⁴ St George’s Hospital, ⁵ Chelsea and Westminster Hospital, ⁶ Mortimer Market Hospital, ⁷ Royal Free Hospital, St Mary’s Hospital, London, UK

INTRODUCTION: There are limited data on the epidemiology of HIVAN in the HAART era. Our objective was to assess the impact of viral suppression with HAART on renal outcome and progression to end-stage renal disease (ESRD).

METHODS: Retrospective study of all HIVAN cases diagnosed between 01/1998 and 12/2004 in London. HIVAN was defined using histological or clinical criteria (proteinuria >1.5 g/d in absence of other medical diagnoses).

RESULTS: The prevalence of HIVAN among black African/black Caribbean patients with newly diagnosed HIV infection was 1.3%, and the incidence among those with established infection was 0.4/1000 py. At HIVAN diagnosis, median age was 36 years; CD4 count 68 cells/µl (IQR = 28–187); viral load 90 875 copies/ml (IQR = 31 500–250 611); serum creatinine 228 µmol/l (IQR = 151–434); and proteinuria 4000 mg/d (IQR = 2340–7800). No patients were HBV/HCV co-infected, and 68% had biopsy-proven HIVAN. HAART was initiated in 36 patients, with a median follow-up of 780 days. Kaplan-Meier survival analyses showed 94% and 80% survival at 1 and 3 years. The proportion of patients who progressed to ESRD at 1 and 3 years was 25% and 33% respectively. There was a statistically significant association between progression to ESRD and incomplete viral suppression on HAART (OR = 6.14, 95% CI = 1.1–34.2, P=0.04), but no association with age, baseline CD4 count, creatinine or level of proteinuria. Conversely, attainment of an undetectable VL versus persistent viraemia was strongly associated with stable or improving renal function (P=0.0011).

CONCLUSION: In this large black African/Caribbean HIVAN cohort, the use of HAART and sustained viral suppression was associated with an improved renal outcome.

2006-03-29
O13

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