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Am J Transplant. 2017 Jul;17(7):1823-1832. doi: 10.1111/ajt.14235. Epub 2017 May 12.

Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors.

Author information

1
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
2
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
3
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
4
University of Washington Center for AIDS Research, Seattle, WA.
5
Mid-Atlantic Permanente Institute, Rockville, MD.
6
Veterans Affairs Connecticut Healthcare System, West Haven, CT.
7
Jesse Brown VA Medical Center and Hines VA Hospital, Chicago, IL.
8
Kaiser Permanente Division of Research, Oakland, CA.
9
Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar.
10
Weill Cornell Medical College, Doha, Qatar.
11
Weill Cornell Medical College, New York, NY.
12
Fenway Health HIV Cohort, Boston, MA.
13
Infectious Diseases Division, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
14
Universidad Central del Caribe, Bayamón, PR.
15
Southern Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada.
16
University of North Carolina, HIV Clinic Cohort, Chapel Hill, NC.
17
The Polyclinic Madison Center, Seattle, WA.
18
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
19
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
20
Department of Surgery, University of Alabama, Birmingham, AL.

Abstract

New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load <400 copies/mL, and CD4+ count ≥500 cells/μL, the 9-year cumulative incidence of ESRD was higher than that of their HIV-negative peers, yet still low: 2.5 versus 1.1 per 10 000 among white women, 3.0 versus 1.3 per 10 000 among white men, 13.2 versus 3.6 per 10 000 among black women, and 15.8 versus 4.4 per 10 000 among black men. HIV-positive individuals with no comorbidities and well-controlled disease may be considered low-risk kidney donor candidates.

KEYWORDS:

clinical research/practice; donors and donation: living; infection and infectious agents; infectious disease; kidney transplantation/nephrology; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)

PMID:
28497525
PMCID:
PMC5489376
DOI:
10.1111/ajt.14235
[Indexed for MEDLINE]
Free PMC Article

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