Kidney function deteriorates more rapidly in older people with HIV than in age-matched controls in both untreated and treated people, suggesting that antiretroviral therapy should be started soon after diagnosis with HIV to protect kidney function, according to UK research presented to the recent 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur.
People with HIV over 70 years of age were at especially high risk of kidney failure, but the risk was also elevated in the over-50s.
Improvements in HIV treatment and care and a high rate of new infections mean that an ever-increasing proportion of HIV-positive people are aged 50 and over. As a result, the diseases of ageing are an increasingly important cause of serious illness and death in people with HIV.
It is well known that kidney function declines with age. An increased risk of renal failure for people with HIV, over and above that seen in the HIV-negative population, has been associated with a low CD4 cell count, a high viral load and treatment with some antiretroviral drugs, especially tenofovir and the protease inhibitors atazanavir, indinavir and lopinavir.
Investigators at the Chelsea and Westminster Hospital wanted to establish the age profile of their patients in the era of antiretroviral therapy and examine changes in kidney function according to age. Declines in kidney function were compared to those observed in age-matched HIV-negative controls and a series of analyses were conducted to see if any risk factors increased the risk of renal failure, which was defined as eGFR below 30 ml/min per 1.73m2.