NDT Advance Access originally published online on July 24, 2006
Nephrology Dialysis Transplantation 2006 21(10):2809-2813; doi:10.1093/ndt/gfl337
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Antiretroviral therapy in the treatment of HIV-associated nephropathy
1Department of Medicine, Division of Nephrology 2Division of Infectious Diseases, Johns Hopkins School of Medicine and the Johns Hopkins Hospital, Baltimore, Maryland 3Department of Medicine, Rosalind Franklin University of Medicine and Sciences, North Chicago, Illinois and 4Department of Pathology, Johns Hopkins School of Medicine and the Johns Hopkins Hospital, Baltimore, Maryland, USA
Correspondence and offprint requests to: Mohamed G. Atta, MD, MPH, Johns Hopkins University, Division of Nephrology, 1830 East Monument Street, Suite 416 Baltimore, Maryland-21205, USA. Email: matta1{at}jhmi.edu
Background. The effect of antiretroviral therapy (ART) on the clinical course of patients with human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is not well-established. This study was undertaken to further elucidate the potential benefit of ART in HIV-infected patients with documented HIVAN.
Methods. A cohort of 263 consecutive HIV-infected patients referred to the Johns Hopkins renal clinic from 1995 to 2004 was examined. Patients were included if they had biopsy-proven HIVAN and did not require dialysis within 1 month of their kidney biopsy. The cumulative probability of renal survival was calculated using the Kaplan–Meier method. Multivariate analysis was performed using the Cox regression method.
Results. Fifty-three patients among 152 biopsied patients had HIVAN. Among 36 patients who met the inclusion criteria, 26 were treated with ART (group I) and 10 patients were not (group II). Except for age, baseline demographics and clinical characteristics were similar in the two groups. Renal survival was significantly better in the group receiving ART by both univariate (P = 0.025) and multivariate analysis (overall adjusted hazard ratio = 0.30; 95% confidence interval 0.09–0.98; P < 0.05) for ART compared with no treatment.
Conclusions. Patients with biopsy-proven HIVAN treated with ART had better renal survival compared with patients who did not receive ART. HIVAN should be considered as an indication to initiate ART.
Keywords: ART; HAART; HIVAN; HIV; kidney biopsy; nephropathy
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