       Document 0712
 DOCN  M95A0712
 TI    Prevalence of viremia in human immunodeficiency virus-infected patients
       with renal disease [see comments]
 DT    9510
 AU    Kimmel PL; VedBrat SS; Pierce PF; Umana WO; Shepherd L; Verme DA; Hirsch
       RP; Hellman KB; Department of Medicine, George Washington University
       Medical; Center, Washington, DC, USA.
 SO    Arch Intern Med. 1995 Aug 7-21;155(15):1578-84. Unique Identifier :
       AIDSLINE MED/95344288
 CM    Comment in: Arch Intern Med 1995 Aug 7-21;155(15):1575-6
 AB    BACKGROUND: The prevalence of viremia and its relationship to the
       pathogenesis of nephropathy in human immunodeficiency virus
       (HIV)-infected patients with renal disease is unknown. To assess the
       prevalence of plasma viremia in HIV-infected patients with chronic renal
       disease, we performed a cohort study in two urban university medical
       centers. METHODS: Samples of blood from 11 HIV-infected patients with
       renal failure who were treated with hemodialysis were analyzed
       concurrently with control samples from three non-HIV-positive patients
       receiving hemodialysis treatment. Samples from four HIV-infected
       patients with chronic renal insufficiency were evaluated concurrently.
       Thirty-three HIV-infected patients with serum creatinine levels of less
       than 132 mumol/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 infections. Blood samples were analyzed for plasma HIV p24
       antigenemia by antigen capture enzyme-linked immunosorbent assay. Blood
       samples were analyzed for the presence of viremia by infection of normal
       stimulated peripheral blood mononuclear cell cultures with plasma
       samples and detection of HIV p24 antigen in culture supernatants.
       RESULTS: Two of the 11 patients treated with hemodialysis had evidence
       of HIV p24 antigenemia, while seven of the 11 had evidence of plasma
       viremia. The proportion of hemodialysis patients with detectable
       antigenemia and viremia was similar to that in patients with chronic
       renal insufficiency. A significantly greater proportion of HIV-infected
       patients with renal disease had plasma viremia and antigenemia, compared
       with HIV-infected patients without renal disease. In logistic regression
       analysis, race, CD4 cell count (either on a continuous scale or
       dichotomized at 0.2 x 10(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 viremia in groups of patients with chronic
       renal insufficiency and with renal disease treated with hemodialysis
       suggest that dialysis treatment does not increase the prevalence of
       plasma viremia in HIV-infected patients with renal disease. The similar
       proportions of HIV-infected hemodialyzed 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 renal disease suggest that plasma
       viremia and renal dysfunction are related. Whether this represents a
       cause and effect relationship is unknown. The greater prevalence of
       viremia in HIV-infected patients with renal disease has implications for
       the pathogenesis of HIV-related renal diseases and for caregivers in
       clinical settings and dialysis units.
 DE    Adult  Case-Control Studies  Cohort Studies  CD4-Positive T-Lymphocytes
       Enzyme-Linked Immunosorbent Assay  Female  *Hemodialysis  Human  HIV
       Antigens/BLOOD  HIV Core Protein p24/IMMUNOLOGY  HIV
       Infections/*COMPLICATIONS/IMMUNOLOGY  Kidney Failure,
       Chronic/*COMPLICATIONS/IMMUNOLOGY/THERAPY  Lymphocyte Count  Male
       Middle Age  Prevalence  Support, U.S. Gov't, P.H.S.
       Viremia/*EPIDEMIOLOGY/IMMUNOLOGY/VIROLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

