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Effect of highly active antiretroviral treatment and prednisone in biopsy-proven HIV-associated nephropathy


, : Effect of highly active antiretroviral treatment and prednisone in biopsy-proven HIV-associated nephropathy. Journal of the American Society of Nephrology 11(Program and Abstract Issue): 93A, September

We retrospectively analyzed 31 black patients with HIVAN diagnosed between 1996 and 1999 followed for at least 12 mo. Patients were grouped into Group 1 (G1) treated with H and P (n=15), Group 2 (G2) treated with H alone (n=7), and Group 3 (G3) not treated with H or P (n=9). Duration of P treatment was 5.5+-0.8 mo. ACEi use (71%) was similar in all groups. Baseline variables (mean+-SEM) were given. Twenty patients reached ESRD (7 in G1, 6 in G2 and 7 in G3). Median time to ESRD (mo) was 13 for G1, 6 for G2 and 4 for G3 (P<0.01). At 12 mo, VL reduction was similar in G1 and G2 (3.7+-0.4 vs. 2.8+-0.4, P=NS), both lower than G3 (5.2+-0.4, P<0.05), and CD4+ count/mL was higher in G2 (267+-65) than in either G1 (162+-29) or G3 (60+-20), (P<0.01). Secondary infection rates were similar among groups (47% for G1, 57% for G2 and 78% for G3, P=0.3). Median renal survival to ESRD was 26 mo for G1, 6 mo for G2 and 3 mo for G3 (P<0.01). G1 patients with undetectable VL had a probability of renal survival of 87% at 33 mo, compared with only 19% in those with detectable VL. All G2 patients with undetectable VL reached ESRD in less than 6 mo. The combination of H and P provided the best probability of renal survival in patients with biopsy-proven HIVAN and was superior to treatment with H alone.

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