Abstract | BACKGROUND: 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.
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Authors | Alice Wei, Godfrey C Burns, Brent A Williams, Nazim B Mohammed, Paul Visintainer, Steven L Sivak |
Journal | Kidney international
(Kidney Int)
Vol. 64
Issue 4
Pg. 1462-71
(Oct 2003)
ISSN: 0085-2538 [Print] United States |
PMID | 12969167
(Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)
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Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
- Anti-Retroviral Agents
- Fosinopril
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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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