13th Annual Conference of the British HIV Association 29 March–1 April 2007, Brighton, UK

ACUTE RENAL FAILURE IN A COHORT OF HIV-INFECTED PATIENTS

HIV Med 2007; 8(Suppl. 1):7 (abstract no. O27)

Jennifer Roe, Lucy Campbell, Philippa Easterbrook, Bruce Hendry and Frank Post
King’s College, London, UK

INTRODUCTION: Acute renal failure (ARF) is an important complication of HIV infection yet remains poorly studied.

METHODS: All HIV+ patients who attended our centre between 1/1998 and 12/ 2005 and had ≥2 consecutive eGFR <60 (mL/min) were reviewed. ARF was defined as a ≥40% reduction of eGFR occurring over <3 months.

RESULTS: During the 8-year study period, 2255 patients attended our clinic (female: 38%, Black: 57%, IVDU: 6%). 114 patients (5.1%) developed ≥1 episodes of ARF. Compared with 2043 patients with persistently normal renal function, patients who developed ARF had lower nadir CD4 counts (median: 64 versus 219, P<0.0001) and more commonly had IVDU as risk factor for HIV (OR 2.93, 95% CI 1.64–5.24). ARF was more common during the first 3 months after initiating HIV care (incidence: 10.3/100 person years), compared to thereafter (incidence: 1.1/100 person years). Patients who experienced ARF within the first 3 months had lower CD4 counts (65 versus 166, P<0.0003) and were less likely to be on HAART at the time of ARF (21% versus 70%, P<0.0001), or have IVDU as risk factor for HIV (2% versus 21%, P<0.01), compared to patients who developed ARF after the initial 3 months. Despite similar severity of ARF (nadir GFR 32 versus 30 mL/min, both 67% reduced from baseline), mortality at 3 months was significantly lower in patients who developed ARF during the initial 3 months (15% versus 38%, P<0.001). Severe (opportunistic) infections, drug toxicity and dehydration were important factors leading to ARF.

CONCLUSION: ARF was common in patients with recently diagnosed HIV infection, and associated with advanced HIV infection. A 10-fold reduction in ARF incidence rate was noted after the initial 3 months. Renal function should be carefully monitored in patients with severe (opportunistic) infections.

2007-03-29
O27

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