PREVALENCE OF VIREMIA IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS WITH RENAL-DISEASE

Background: The prevalence of viremia and its relationship to the path ogenesis of nephropathy in human immunodeficiency virus (HIV)-infected patients with renal disease is unknown. To assess the prevalence of p lasma viremia in HIV-infected patients with chronic renal disease, we performed a cohort study in two urban university medical centers. Meth ods: Samples of blood from 11 HIV-infected patients with renal failure who were treated with hemodialysis were analyzed concurrently with co ntrol samples from three non-HIV-positive patients receiving hemodialy sis treatment. Samples from four HIV-infected patients with chronic re nal insufficiency were evaluated concurrently. Thirty-three HIV-infect ed patients with serum creatinine levels of less than 132 mu mol/L (1. 5 mg/dL), and trace or absent dipstick proteinuria served as controls for the population with renal disease, The patients infected with HIV were staged by CD4 cell counts and the presence of opportunistic infec tions. Blood samples were analyzed for plasma HIV p24 antigenemia by a ntigen capture enzyme-linked immunosorbent assay. Blood samples were a nalyzed for the presence of viremia by infection of normal stimulated peripheral blood mononuclear cell cultures with plasma samples and det ection of HIV p24 antigen in culture supernatants. Results: Two of the 11 patients treated with hemodialysis had evidence of HIV p24 antigen emia, while seven of the 11 had evidence of plasma viremia. The propor tion of hemodialysis patients with detectable antigenemia and viremia was similar to that in patients with chronic renal insufficiency. A si gnificantly greater proportion of HIV-infected patients with renal dis ease had plasma viremia and antigenemia, compared with HIV-infected pa tients without renal disease. In logistic regression analysis, race, C D4 cell count (either on a continuous scale or dichotomized at 0.2X10( 9)/L), and treatment with zidovudine were not significantly associated with the presence of plasma viremia, but patient age and the presence of renal disease were factors independently associated with viremia. Conclusions: The similar proportions of HIV-infected patients with vir emia in groups of patients with chronic renal insufficiency and with r enal disease treated with hemodialysis suggest that dialysis treatment does not increase the prevalence of plasma viremia in HIV-infected pa tients with renal disease, The similar proportions of HIV-infected hem odialyzed patients and patients with chronic renal insufficiency with plasma viremia, and the greater prevalence of viremia in patients with renal disease compared with HIV-infected patients without clinical re nal disease suggest that plasma viremia and renal dysfunction are rela ted. Whether this represents a cause and effect relationship is unknow n. The greater prevalence of viremia in HIV-infected patients with ren al disease has implications for the pathogenesis of HIV-related renal diseases and for caregivers in clinical settings and dialysis units.