Methods: This is a retrospective cohort analysis of HIV-infected adults enrolled in the DC Cohort study at Georgetown University Hospital. Clinical and laboratory data were extracted from electronic medical records of consenting adults. Kidney function (eGFR) was estimated using the CKD-EPI formula. Descriptive statistics were derived using tests to determine differences by co-infection status. Multivariate logistic regression (MVR) was used to identify factors associated with reduced kidney function (SAS v9.4).
Results: Among 771 HIV-infected patients enrolled between 2011-2014, the median age was 48 years, 73.4% were male, 50.3% Black, median enrollment CD4 546.5 cells/µL and HIV RNA <20 copies/mL, and 93 (12.1%) were HCV co-infected. Higher prevalence of CKD stages 2-5 (35.4 vs. 21.4%, p=0.0049) among co-infected. Combination antiretroviral therapy regimens differed by HCV status with greater integrase strand transfer inhibitor (INSTI) usage with co-infection (44.1 vs. 24.6%, p=0.0002) and more Tenofovir disoproxil fumarate (TDF) (69.8 vs. 60.2%, p=0.0197) and non-nucleoside reverse transcriptase inhibitor (32.9 vs. 19.4%, p=0.0048) usage with HIV mono-infection. In MVR analysis, older age (OR 1.08 (95% CI: 1.06 – 1.11); p= <0.0001), Hepatitis B (2.45 (1.16 – 5.18); p= 0.0187), and current INSTI use (1.77 (1.12 – 2.80); p=0.0142) was significantly associated with reduced eGFR (<90 mL/min/1.73 m2) but not current TDF use (0.41 (0.26 – 0.64); 0.0142).
Conclusion: We identified differential antiretroviral usage patterns with HIV/HCV co-infection. Higher INSTI use may be driven by efforts to minimize drug interactions with HCV medications. The apparent protective effect of TDF was surprising given the inherent risk for kidney dysfunction conferred by TDF. Further studies are needed to determine the underlying pathophysiology of kidney dysfunction modulated by HCV infection and antiviral agents.
N. Nigam, None
J. Umans, None
P. Kumar, None
S. Kassaye, None
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