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Chronic kidney disease (CKD) in HIV‐infected patients is associated with both HIV and non‐HIV‐related factors. Initial renal dysfunction is silent and detectable only by laboratory tests such as the glomerular filtration rate (GFR) estimated by the Cockcroft‐Gault equation. Our objective was to assess possible risk factors for CKD in a cohort of Greek HIV‐1‐infected adults.MethodsPatients in the AMACS (Athens Multicenter AIDS Cohort Study) cohort with at least two available creatinine values were enrolled in the study. Renal dysfunction was defined as eGFR below 90 mL/min/1.73 m2. The Kaplan‐Meier estimator and the Cox proportional hazards model were used to analyze the occurrence and predictors of renal dysfunction.ResultsA total of 1073 patients were enrolled in the study; 255 (23.76%) had baseline eGFR below 90 mL/min/1.73 m2 and were excluded. Characteristics of the study population: men 88.4%, MSM 62.6%, median baseline age, CD4+count and viral load were 32.6 years, 413 cells/µL and 3.77 log10 copies/mL, respectively. 240 (29.3%) patients experienced an eGFR decrease below 90 mL/min/1.73 m2 during follow‐up period. Older age, female gender, heterosexual mode of transmission, lower baseline eGFR (all p<0.001), lower baseline CD4+(p=0.001), stage C (p=0.023), administration of cART (p<0.001) or other nephrotoxic agent (p=0.035) were the major risk factors in univariable analysis. Multivariable analysis identified older age [hazard ratio (HR) 1.289 per 10 years, p<0.001] and female gender (HR vs male: 1.899, p<0.001), as the major factors associated with increased hazard of developing CRD, whereas baseline eGFR <110 (HR vs eGFR <110: 0.245, p<0.001) and current CD4+count ≥350 cells/µL (HR 0.564, p=0.003) were significant protective factors.ConclusionIn this large cohort of HIV‐infected Greek patients, almost one‐third (29.3%) experienced some degree of renal dysfunction during HIV infection. Older age and female gender were major predictors of CKD, whereas high current CD4+count and baseline eGFR were protective.

Purpose of the studyThe prevalence of neurocognitive impairment (NCI) in people living with HIV has previously been reported between 20–50%, with prevalence rates of depression reported between 12–71%. The primary objective of the CRANIum study was to describe the prevalence of a positive screen for NCI and depression/anxiety in an HIV‐1‐infected adult population, comparing ARV‐naïve and ‐experienced patients. Here we present an ethnicity analysis of the CRANIum data.MethodsThe study was an epidemiologic, cross‐sectional study that included HIV‐1‐infected patients >18 years old attending a routine clinic visit. One‐third of patients were ART‐naïve, one‐third on a PI/r‐ and one‐third on a NNRTI‐based regimen. The Brief Neurocognitive Screen (BNCS) was used to screen for NCI. It consists of the Digit Symbol and Trailmaking A and B tests. A standard deviation of >1 on 2 tests or >2 on 1 test was considered a positive screen for NCI. The Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety (HADS‐A) and depression (HADS‐D). HADS is self‐administered and consists of 14 items (7 HADS‐A, 7 HADS‐D) scored between 0 to 3. A score of ≥8 was considered as a positive screen for either condition.Summary of results2859 evaluable patients were included from 15 countries. Baseline characteristics are shown in table 1 (*p < 0.05 as compared with Caucasian group). Overall, 41.4% of patients had a positive screen for NCI, 33.3% for anxiety and 15.7% for depression. Results by ethnicity are shown in figure 1.













All subjects
Caucasian
Black
Hispanic
Oriental/Asian
Other




Number of subjects (%)
2859
2254 (78.8)
387 (13.5)
127 (4.4)
50 (1.7)
41 (1.4)


Age ‐ mean, years
42.95
43.80
39.79*
38.56*
40.57*
42.96


Gender ‐%


   ‐ Male
61.7
67.3
26.9*
70.1
64.0
56.1


   ‐ Female
38.3
32.7
73.1*
29.9
36.0
43.9


   Unemployed ‐%
33.1
32.8
35.7
26.0
30.0
51.2*


   > Secondary school education ‐%
82.2
81.3
84.2
89.0*
90.0
78.0


HIV risk factor ‐%


   ‐ Homosexual
42.5
48.5
4.1*
58.3*
36.0
31.7


   ‐ Heterosexual
44.8
37.3
89.4*
39.4*
46.0
51.2


   ‐ Other/ Not known
12.8
14.2
6.5*
2.4*
18.0
17.1


   Duration of HIV infection – mean, months
98.10
103.22
73.46*
79.80*
82.16
113.84


Last recorded HIV‐1 RNA level


   ‐ ART‐naïve‐ median, c/mL
22,390
23,539
11,483
32,241
23,112
12,660


   ‐ ART‐experienced – median, c/mL
39.0
39.0
40.0
28.0
40.0
39.5


   Last recorded CD4 count – mean, c/µL
586.02
598.70
527.57*
550.17
542.40
599.43


   Previous AIDS diagnosis ‐%
17.5
17.7
16.6
17.3
16.0
19.5


   Previous CNS infection ‐%
4.5
3.6
7.2*
6.3
6.0
17.1*


   CD4 count nadir (mean, cells/µL)
295.02
302.65
255.01*
311.97
259.10
247.63


   Hepatitis C co‐infection ‐%
12.4
14.7
1.6*
3.9*
16.0
12.2


   Previous psychiatric diagnosis ‐%
20.2
22.2
9.8*
15.9
20.0
17.1





imageConclusionsIn this large epidemiologic study, the overall prevalence of a positive screen for NCI was high. In particular, the rate in black patients was nearly double that of the overall study population. This finding needs to be interpreted in light of differences in demographics and disease characteristics between ethnic groups. The overall prevalence of a positive screen for depression in HIV‐infected patients was nearly double what has previously been reported in the non‐HIV‐infected population in Europe when utilizing a similar screening tool, with no significant differences between identified ethnic groups. These results support a strategy of regular screening for, and clinical management of NCI, depression, and anxiety in all HIV‐infected patients, with specific focus on NCI in the black population.

Publisher's version (útgefin grein) ; Objectives There are currently few data on the long‐term risk of cancer and death in individuals taking raltegravir (RAL). The aim of this analysis was to evaluate whether there is evidence for an association. Methods The EuroSIDA cohort was divided into three groups: those starting RAL‐based combination antiretroviral therapy (cART) on or after 21 December 2007 (RAL); a historical cohort (HIST) of individuals adding a new antiretroviral (ARV) drug (not RAL) to their cART between 1 January 2005 and 20 December 2007, and a concurrent cohort (CONC) of individuals adding a new ARV drug (not RAL) to their cART on or after 21 December 2007. Baseline characteristics were compared using logistic regression. The incidences of newly diagnosed malignancies and death were compared using Poisson regression. Results The RAL cohort included 1470 individuals [with 4058 person‐years of follow‐up (PYFU)] compared with 3787 (4472 PYFU) and 4467 (10 691 PYFU) in the HIST and CONC cohorts, respectively. The prevalence of non‐AIDS‐related malignancies prior to baseline tended to be higher in the RAL cohort vs. the HIST cohort [adjusted odds ratio (aOR) 1.31; 95% confidence interval (CI) 0.95–1.80] and vs. the CONC cohort (aOR 1.89; 95% CI 1.37–2.61). In intention‐to‐treat (ITT) analysis (events: RAL, 50; HIST, 45; CONC, 127), the incidence of all new malignancies was 1.11 (95% CI 0.84–1.46) per 100 PYFU in the RAL cohort vs. 1.20 (95% CI 0.90–1.61) and 0.83 (95% CI 0.70–0.99) in the HIST and CONC cohorts, respectively. After adjustment, there was no evidence for a difference in the risk of malignancies [adjusted rate ratio (RR) 0.73; 95% CI 0.47–1.14 for RALvs. HIST; RR 0.95; 95% CI 0.65–1.39 for RALvs. CONC] or mortality (adjusted RR 0.87; 95% CI 0.53–1.43 for RALvs. HIST; RR 1.14; 95% CI 0.76–1.72 for RALvs. CONC). Conclusions We found no evidence for an oncogenic risk or poorer survival associated with using RAL compared with control groups. ; EuroSIDA was supported by the European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement no. 260694. Current support includes unrestricted grants from Bristol‐Myers Squibb, Gilead, GlaxoSmithKline LLC, Janssen R&D, Merck and Co. Inc. and Pfizer Inc. The participation of centres from Switzerland was supported by The Swiss National Science Foundation (Grant 108787). The study is also supported by a grant (grant number DNRF126) from the Danish National Research Foundation. ; Peer Reviewed