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

• Published in: Kidney international Vol. 64; no. 4; pp. 1462 - 1471
• Main Authors: Wei, Alice, Burns, Godfrey C., Williams, Brent A., Mohammed, Nazim B., Visintainer, Paul, Sivak, Steven L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2003; Nature Publishing; Elsevier Limited
• Subjects: Adult; AIDS-Associated Nephropathy - complications; AIDS-Associated Nephropathy - drug therapy; AIDS-Associated Nephropathy - physiopathology; angiotensin-converting enzyme inhibition; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Anti-Retroviral Agents - therapeutic use; Biological and medical sciences; Cohort Studies; Female; focal segmental glomerulosclerosis; Fosinopril - therapeutic use; HIV-associated nephropathy; Human immunodeficiency virus; Humans; Kidney Failure, Chronic - etiology; Kidneys; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; nephrotic; proteinuria; Survival Analysis; Urinary system involvement in other diseases. Miscellaneous; HIV-associated nephropathy; nephrotic; angiotensin-converting enzyme inhibition; focal segmental glomerulosclerosis; proteinuria; Association; Cohort study; Complication; Kidney disease; Human; Immunopathology; Urinary system disease; Survivor; Retroviridae; AIDS; Terminal stage; Immune deficiency; Lentivirus; Long term; Infection; Virus; Chemotherapy; Nephropathy; Treatment; Viral disease; Risk factor; Renal failure; Human immunodeficiency virus; ACE inhibitor
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.2003.00230.x

Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition. 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. 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 ≤2.0mg/dL), throughout the study period of 1890 days (5.1 years). Twenty-eight patients received fosinopril, 10mg/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. 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 ≥two antiviral drugs for ≥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). 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.