{"id":40105,"date":"2021-03-12T07:29:30","date_gmt":"2021-03-12T07:29:30","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=40105"},"modified":"2021-03-12T14:01:36","modified_gmt":"2021-03-12T14:01:36","slug":"chronic-kidney-disease-ckd-in-hiv-positive-people-linked-to-time-with-low-cd4-count-partly-reversible-after-effective-art","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/40105","title":{"rendered":"Chronic kidney disease (CKD) in HIV positive people linked to time with low CD4 count: partly reversible after effective ART"},"content":{"rendered":"<p><strong>Simon Collins, HIV i-Base<\/strong><\/p>\n<p><strong>The large prospective D:A:D cohort, with approximately 49,000 participants, looked at a range of markers of HIV-related immunosuppression, including baseline, nadir and recovery CD4 counts and time spent &lt;200 cells\/mm<sup>3<\/sup>.\u00a0<\/strong><\/p>\n<p>This analysis included 33,791 participants followed from 2004 to 2016. During a median of 8 years follow-up,\u00a02226 participants (6.6%) developed CKD, defined as eGFR &lt;60 \u00a0mL\/min\/1.73. The majority (6.3%) developed grade 3 (eGFR &lt;60 to &gt;30).<\/p>\n<p>However, 0.3% developed grade 4 and 0.3% grade 5, with 0.1% needing chronic dialysis and 0.01% a kidney transplant.<\/p>\n<p>In univariate analysis, all measures of immunosuppression measures predicted CKD.<\/p>\n<p>In mutivariate analysis, including all factors in the D:A:D 5-year CKD calculator, the strongest predictor was the percentage of time spent with a CD4 \u2264200 cells\/mm<sup>3<\/sup>: 0 vs &gt;25%; IRR: 0.77 (95%CI: \u00a00.68 to 0.88).<\/p>\n<p>The highest effect was in people at low D:A:D CKD risk: IRR 0.45 (95% CI: 0.24 to 0.80) vs 0.80 (95% CI: 0.70 to 0.93).<\/p>\n<p>Of the 4328 with baseline CD4 &lt;200 cells\/mm<sup>3<\/sup>, 309 developed CKD.<\/p>\n<p>The results also suggested that the increased risk from severe immunosuppression may be at least partially reversible after immune recovery to &gt;500 cells\/mm<sup>3<\/sup> on ART when CKD was rare.<\/p>\n<h3>comment<\/h3>\n<p><strong>Although this study was presented in part at CROI 2016, the publication of the full dataset is important to report.<\/strong><\/p>\n<p>Reference<\/p>\n<p>Ryom L et al. The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study.JID\u00a0\u00a0223(4):632\u2013637. DOI:10.1093\/infdis\/jiaa396. (5 February 2021).<br \/>\n<a href=\"https:\/\/academic.oup.com\/jid\/article\/223\/4\/632\/5868947\">https:\/\/academic.oup.com\/jid\/article\/223\/4\/632\/5868947<\/a><\/p>\n<p><em>This report was first posted on 1 March 2021.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Simon Collins, HIV i-Base The large prospective D:A:D cohort, with approximately 49,000 participants, looked at a range of markers of HIV-related immunosuppression, including baseline, nadir and recovery CD4 counts and time spent &lt;200 cells\/mm3.\u00a0 This analysis included 33,791 participants followed &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,31],"tags":[],"class_list":["post-40105","post","type-post","status-publish","format-standard","hentry","category-side-effects","category-opportunistic-infections-coinfections-and-complications"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=40105"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40105\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=40105"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=40105"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=40105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}