PMID- 25933346
OWN - NLM
STAT- MEDLINE
DCOM- 20160126
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 10
IP  - 5
DP  - 2015
TI  - Evaluation of the Prognostic Value of Impaired Renal Function on Clinical 
      Progression in a Large Cohort of HIV-Infected People Seen for Care in Italy.
PG  - e0124252
LID - 10.1371/journal.pone.0124252 [doi]
LID - e0124252
AB  - Whilst renal dysfunction, especially mild impairment (60<eGFR<90 ml/min), has 
      been often described in HIV-infected population, its potential contribution to 
      HIV evolution and risk of cerebro-cardiovascular disease (CCVD) has not been 
      clarified. Data from HIV-1 infected patients enrolled in the Italian Cohort of 
      Antiretroviral-Naive (Icona) Foundation Study collected between January 2000 and 
      February 2014 with at least two creatinine values available. eGFR (CKD-epi) and 
      renal dysfunction defined using a priori cut-offs of 60 (severely impaired) and 
      90 ml/min/1.73 m2 (mildly impaired). Characteristics of patients were described 
      after stratification in these groups and compared using chi-square test 
      (categorical variables) or Kruskal Wallis test comparing median values. Follow-up 
      accrued from baseline up to the date of the CCVD or AIDS related events or death 
      or last available visit. Kaplan Meier curves were used to estimate the cumulative 
      probability of occurrence of the events over time. Adjusted analysis was 
      performed using a proportional hazards Cox regression model. We included 7,385 
      patients, observed for a median follow-up of 43 months (inter-quartile range 
      [IQR]: 21-93 months). Over this time, 130 cerebro-cardiovascular events 
      (including 11 deaths due to CCVD) and 311 AIDS-related events (including 45 
      deaths) were observed. The rate of CCVD events among patients with eGFR >90, 
      60-89, <60 ml/min, was 2.91 (95% CI 2.30-3.67), 4.63 (95% CI 3.51-6.11) and 11.9 
      (95% CI 6.19-22.85) per 1,000 PYFU respectively, with an unadjusted hazard ratio 
      (HR) of 4.14 (95%CI 2.07-8.29) for patients with eGFR <60 ml/min and 1.58 (95%CI 
      1.10-2.27) for eGFR 60-89 compared to those with eGFR >/=90. Of note, these 
      estimates are adjusted for traditional cardio-vascular risk factors (e.g. 
      smoking, diabetes, hypertension, dyslipidemia). Incidence of AIDS-related events 
      was 9.51 (95%CI 8.35-10.83), 6.04 (95%CI 4.74-7.71) and 25.0 (95%CI 15.96-39.22) 
      per 1,000 PYFU, among patients with eGFR >90, 60-89, <60 ml/min, respectively, 
      with an unadjusted HR of 2.49 (95%CI 1.56-3.97) for patients with eGFR <60 ml/min 
      and 0.68 (95%CI 0.52-0.90) for eGFR 60-89. The risk of AIDS events was 
      significantly lower in mild renal dysfunction group even after adjustment for 
      HIV-related characteristics. Our data confirm that impaired renal function is an 
      important risk marker for CCVD events in the HIV-population; importantly, even 
      those with mild renal impairment (90<eGFR<60) seem to be at increased risk of 
      cerebro-cardiovascular morbidity and mortality.
FAU - Bandera, Alessandra
AU  - Bandera A
AD  - Division of Infectious Diseases, Department of Internal Medicine, San Gerardo 
      Hospital, University of Milano-Bicocca, Monza, Italy.
FAU - Gori, Andrea
AU  - Gori A
AD  - Division of Infectious Diseases, Department of Internal Medicine, San Gerardo 
      Hospital, University of Milano-Bicocca, Monza, Italy.
FAU - Sabbatini, Francesca
AU  - Sabbatini F
AD  - Division of Infectious Diseases, Department of Internal Medicine, San Gerardo 
      Hospital, University of Milano-Bicocca, Monza, Italy.
FAU - Madeddu, Giordano
AU  - Madeddu G
AD  - Department of Infectious Diseases, University of Sassari, Sassari, Italy.
FAU - Bonora, Stefano
AU  - Bonora S
AD  - Department of Infectious Diseases of the University of Torino, Amedeo di Savoia 
      Hospital, Torino, Italy.
FAU - Libertone, Raffaella
AU  - Libertone R
AD  - National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
FAU - Mastroianni, Claudio
AU  - Mastroianni C
AD  - Department of Infectious and Tropical Diseases, Sapienza University, Polo 
      Pontino, Latina, Italy.
FAU - Bonfanti, Paolo
AU  - Bonfanti P
AD  - Infectious Diseases Unit, Alessandro Manzoni Hospital, Lecco, Italy.
FAU - d'Arminio Monforte, Antonella
AU  - d'Arminio Monforte A
AD  - Clinic of Infectious Diseases and Tropical Medicine, University of Milan, San 
      Paolo Hospital, Milan, Italy.
FAU - Cozzi-Lepri, Alessandro
AU  - Cozzi-Lepri A
AD  - University College London, London, United Kingdom.
CN  - Icona Foundation Study Group
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150501
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adult
MH  - Cardiovascular Diseases/etiology/physiopathology
MH  - Cohort Studies
MH  - *Disease Progression
MH  - Female
MH  - Follow-Up Studies
MH  - Glomerular Filtration Rate
MH  - HIV Infections/*pathology/*physiopathology
MH  - Humans
MH  - Italy/epidemiology
MH  - *Kidney Function Tests
MH  - Male
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Risk Factors
PMC - PMC4416769
COIS- Competing Interests: ICONA Foundation Study is sponsored by unrestricted grants 
      from AbbVie, Briston Myers-Squibb, Gilead, Jannsen, Merck Sharp & Dohme, ViiV 
      Italy. However, the funders had no role in study design, data collection and 
      analysis, decision to publish, or preparation of the manuscript. This does not 
      alter the authors' adherence to PLOS ONE policies on sharing data and materials. 
      The authors declare that no competing interests exist.
FIR - Giacometti, A
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FIR - Costantini, A
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FIR - Mazzoccato, S
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FIR - Angarano, G
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FIR - Suardi, C
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FIR - Viale, P
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FIR - Borderi, M
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FIR - Vanino, E
IR  - Vanino E
FIR - Verucchi, G
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FIR - Castelli, F
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FIR - Quiros Roldan, E
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FIR - Mastroianni, C
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FIR - Sciandra, M
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FIR - Londero, A
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FIR - Pellizzer, G
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FIR - Manfrin, V
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FIR - Cozzi-Lepri, A
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EDAT- 2015/05/02 06:00
MHDA- 2016/01/27 06:00
PMCR- 2015/05/01
CRDT- 2015/05/02 06:00
PHST- 2015/01/07 00:00 [received]
PHST- 2015/03/12 00:00 [accepted]
PHST- 2015/05/02 06:00 [entrez]
PHST- 2015/05/02 06:00 [pubmed]
PHST- 2016/01/27 06:00 [medline]
PHST- 2015/05/01 00:00 [pmc-release]
AID - PONE-D-14-57747 [pii]
AID - 10.1371/journal.pone.0124252 [doi]
PST - epublish
SO  - PLoS One. 2015 May 1;10(5):e0124252. doi: 10.1371/journal.pone.0124252. 
      eCollection 2015.