Increased prevalence of albuminuria in HIV-infected adults with diabetes

• Published in: PloS one 2011-09, Vol.6 (9), p.e24610
• Main Authors: Kim, Peter S, Woods, Christian, Dutcher, Lauren, Georgoff, Patrick, Rosenberg, Alice, Mican, Jo Ann M, Kopp, Jeffrey B, Smith, Margo A, Hadigan, Colleen
• Format: Article
• Language: English
• Subjects: Abacavir; Acquired immune deficiency syndrome; Adult; Adults; AIDS; Albumin; Albuminuria - epidemiology; Albuminuria - etiology; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Biology; Blood pressure; Blood Pressure - physiology; Body mass; Body Mass Index; CD4-Positive T-Lymphocytes - immunology; Collaboration; Creatinine; Cross-Sectional Studies; Development and progression; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes therapy; Diabetics; Dideoxynucleosides - adverse effects; Dideoxynucleosides - therapeutic use; Drug therapy; Exposure; Family medical history; Female; Glomerular Filtration Rate - physiology; Health risks; Heart attacks; HIV; HIV infections; HIV Infections - complications; HIV Infections - epidemiology; Hospitals; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Inflammation; Kidney diseases; Male; Medical records; Medical research; Medicine; Middle Aged; Mortality; Multivariate Analysis; Regression analysis; Research design; Risk analysis; Risk factors; Risk management; Type 2 diabetes; Urine; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0024610

HIV and type 2 diabetes are known risk factors for albuminuria, but no previous reports have characterized albuminuria in HIV-infected patients with diabetes. We performed a cross-sectional study including 73 HIV-infected adults with type 2 diabetes, 82 HIV-infected non-diabetics, and 61 diabetic control subjects without HIV. Serum creatinine >1.5 mg/dL was exclusionary. Albuminuria was defined as urinary albumin/creatinine ratio >30 mg/g. The prevalence of albuminuria was significantly increased among HIV-infected diabetics (34% vs. 13% of HIV non-diabetic vs. 16% diabetic control, p = 0.005). HIV status and diabetes remained significant predictors of albuminuria after adjusting for age, race, BMI, and blood pressure. Albumin/creatinine ratio correlated significantly with HIV viral load (r = 0.28, p = 0.0005) and HIV-infected subjects with albuminuria had significantly greater cumulative exposure to abacavir (p = 0.01). In an adjusted multivariate regression analysis of HIV-infected subjects, the diagnosis of diabetes (p = 0.003), higher HIV viral load (p = 0.03) and cumulative exposure to abacavir (p = 0.0009) were significant independent predictors of albuminuria. HIV and diabetes appear to have additive effects on albuminuria which is also independently associated with increased exposure to abacavir and HIV viral load. Future research on the persistence, progression and management of albuminuria in this unique at-risk population is needed.