Rhee M, Schmid C, Stevens L, Tang AM, Forrester J. Risk factors for proteinuria in HIV-infected and -uninfected Hispanic drug abusers. 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention incorporating the 19th ASHM Conference, July 22-25, 2007, Sydney, Australia. Abstract #MOPEB071.
Objectives: Proteinuria may be an early marker of chronic kidney disease in HIV-infected patients with coexisting chronic hepatitis and/or substance abuse. Minorities may be at higher risk of chronic kidney disease. This study was conducted to identify independent risk factors of proteinuria in a cohort of HIV-infected and -uninfected Hispanic drug abusers.
Methods: Secondary cross sectional analyses were conducted using data collected from 2002-05 in a study of the role of drug abuse in HIV-associated malnutrition in a street-recruited Hispanic cohort, comprised of four groups (HIV-infected drug abusers, n=107; HIV-infected non-drug abusers, n=38; HIV-uninfected drug abusers, n=97; healthy controls, n=50). Patients on renal replacement therapy were excluded. Proteinuria was defined as urine dipstick >= 1+.
Results: 287 subjects were included. Mean age was 39 (range: 18-76). 24(8.4%) had proteinuria. Estimated glomerular filtration rate(eGFR) was 106.8±22.6. Subjects with proteinuria were more likely than those without to have hypertension(7(29%) vs 29(11%), p=0.02), diabetes(10(42%) vs 10(4%), p<0.0001), HIV infection(22(92%) vs 122(46%), p<0.0001), and history of intravenous drug use(IDU)(19(79%) vs 129(49%), p=0.005). Subjects with proteinuria did not differ significantly by age, gender, eGFR, chronic hepatitis or current IDU. In a multivariate logistic regression model, variables significantly associated with proteinuria (OR, 95% CI) were HIV(11.0, 2.1-56.5, p=0.004), prior IDU(7.4, 2.1-26.6, p=0.002), hypertension(3.7, 1.1-12.3, p=0.04), diabetes (23.6, 6.1-90.8, p<0.0001), and female gender(4.4, 1.3-14.2, p=0.01). Age, chronic hepatitis and current IDU were not associated with proteinuria in univariate and multivariate models.
Conclusion: HIV and prior IDU, but not chronic hepatitis or current IDU, are independently associated with proteinuria in Hispanic drug abusers. HIV-infected Hispanics with prior IDU, particularly those with hypertension or diabetes, may be at high risk of having proteinuria and should be screened. Longitudinal studies to assess the development of proteinuria and chronic kidney disease in this high risk population is warranted.
