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Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition.

AbstractBACKGROUND:
Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is the most common cause of end-stage renal disease (ESRD) in HIV-infected patients. Angiotensin-converting enzyme (ACE) inhibition has previously shown a short-term benefit in HIVAN. This study examines the long-term effects of ACE inhibition on renal survival in HIVAN.
METHODS:
In this single-center prospective cohort study, 44 patients with biopsy-proven HIVAN were enrolled prior to the onset of severe renal insufficiency (serum creatinine <or=2.0 mg/dL), throughout the study period of 1890 days (5.1 years). Twenty-eight patients received fosinopril, 10 mg/day, and 16 were followed as controls. End points included ESRD and death. Treatment effects on survival were evaluated with Kaplan-Meier product-limit estimates. Survival is also described as absolute median number of days.
RESULTS:
Median renal survival of treated patients was 479.5 days, with only one patient developing ESRD. All untreated controls progressed to ESRD, with a median renal survival of 146.5 days (P < 0.0001). There were no significant differences between treatment and control groups in age, significant exposure to antiretroviral therapy, defined as >or=two antiviral drugs for >or=30 consecutive days, CD4 lymphocyte count, initial median serum creatinine concentration, or proteinuria. Risk of renal failure was reduced with ACE inhibitors (RR = 0.003, P < 0.0001). Exposure to antiretroviral therapy did not have a significant impact on the risk of renal failure. Of the ACE inhibitor-treated group, 87.5% survived compared with 21.4% of the control group (P < 0.001).
CONCLUSION:
ACE inhibition initiated prior to severe renal insufficiency may offer long-term renal survival benefits in HIVAN. Diagnosis should be sought early in patients with clinical signs suggestive of HIVAN.
AuthorsAlice Wei, Godfrey C Burns, Brent A Williams, Nazim B Mohammed, Paul Visintainer, Steven L Sivak
JournalKidney international (Kidney Int) Vol. 64 Issue 4 Pg. 1462-71 (Oct 2003) ISSN: 0085-2538 [Print] United States
PMID12969167 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)
Chemical References
  • Angiotensin-Converting Enzyme Inhibitors
  • Anti-Retroviral Agents
  • Fosinopril
Topics
  • AIDS-Associated Nephropathy (complications, drug therapy, physiopathology)
  • Adult
  • Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
  • Anti-Retroviral Agents (therapeutic use)
  • Cohort Studies
  • Female
  • Fosinopril (therapeutic use)
  • Humans
  • Kidney Failure, Chronic (etiology)
  • Male
  • Middle Aged
  • Survival Analysis

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