1655. Hepatitis C Co-infection in HIV Patients on Tenofovir-containing Anti-retroviral Therapy Increases the Incidence of Renal failure
Session: Poster Abstract Session: HIV: Renal Issues in HIV-Infected Patients
Saturday, October 10, 2015
Room: Poster Hall
Background: Hepatitis C virus (HCV) infection and tenofovir use are each risk factors for acute and chronic kidney injury in HIV patients.    We sought to examine the role of HCV and other risk factors in the development of renal failure in patients on tenofovir-containing anti-retroviral regimens.

Methods: We conducted a retrospective cohort study using the Penn State Hershey Medical Center HIV database to identify patients on a tenofovir-containing regimen from 2002 to 2015.  We defined HCV infection based on HCV antibody status and renal failure as a 25% change in estimated GFR (eGFR) from baseline with a minimal follow-up of 3 months.  A multivariable survival analysis using the Cox model with estimates of hazard ratios (HR) and 95% confidence intervals (CI) were used to examine risk factors and time to renal failure. 

Results: A total of 707 HIV patients with 141 co-infected with hepatitis C received tenofovir for a mean of 5.1 years.  Baseline eGFR was greater than 60 ml/min/1.73m2 in 96% of patients.  During the study period 42% of HIV/HCV co-infected patients developed renal failure in a mean time of 39 months compared to 32% in HIV mono-infected patients in 41 months (p=0.02).  Mean decrease in eGFR was 38 ml/min/1.72m2 in co-infected patients compared to 33 ml/min/1.72m2 in mono-infected patients (p=0.03).  Presence or absence of HCV viral load did not affect renal failure prevalence in the HIV/HCV cohort (45% vs. 42%, p=0.66).  Multivariable survival analysis indicated HIV/HCV co-infected patients were more likely to develop renal failure than HIV mono-infected patients (HR 1.48, CI 1.01-2.15; p=0.04).  Female gender (HR 1.53, CI 1.06-2.22; p=0.02), increasing age (HR 1.02, CI 1.002-1.03; p<0.03), decreasing BMI (HR 0.97, CI 0.95-0.999); p=0.04), concurrent protease inhibitor use (HR 1.71, CI 1.31-2.24; p<0.0001), and baseline CD4 count <200 cells/mm3(HR 1.41, CI 1.04-1.90; p<0.03) were also independently associated with renal failure.  

Conclusion:

HIV patients on a tenofovir-containing regimen have a greater risk of developing renal failure if they have HCV co-infection, female gender, older age, low BMI, baseline CD4 count <200 cells/mm3 and concurrent protease inhibitor use.  These findings should help clinicians perform a risk assessment when starting or continuing HIV/HCV patients on tenofovir-based regimens.

Juhi Moon, MD, Infectious Disease, Penn State Hershey Medical Center, Hershey, PA, Yingzhi Chen, MPH, Public Health Science, Penn State Hershey Medical Center, Hershey, PA, Ping Du, MD, PhD, Medicine/Public Health Sciences, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA and Tonya Crook, MD, Medicine/Infectious Diseases, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA

Disclosures:

J. Moon, None

Y. Chen, None

P. Du, None

T. Crook, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.