The Incidence of and Risk Factors for Hospitalized Acute Kidney Injury Among People Living With HIV on Antiretroviral Treatment

Anthony N. Muiru; Erin Madden; Ani Chilingirian; Anna D. Rubinsky; Rebecca Scherzer; Richard Moore; Celia P. Corona Villalobos; Jose Manuel Monroy Trujillo; Chirag R. Parikh; Chi-yuan Hsu; Michael G. Shlipak; Michelle M. Estrella


HIV Medicine. 2022;23(6):611-619. 

In This Article

Abstract and Introduction


Objectives: The epidemiology of hospitalized acute kidney injury (AKI) among people living with HIV (PLWH) in the era of modern antiretroviral therapy (ART) for all PLWH is not well characterized. We evaluated the incidence of and risk factors for hospitalized AKI from 2005 to 2015 among PLWH on ART.

Methods: We conducted a retrospective analysis of PLWH from the Johns Hopkins HIV Clinical Cohort. We defined hospitalized AKI as a rise of ≥ 0.3 mg/dL in serum creatinine (SCr) within any 48-h period or a 50% increase in SCr from baseline and assessed associations of risk factors with incident AKI using multivariate Cox regression models.

Results: Most participants (75%) were black, 34% were female, and the mean age was 43 years. The incidence of AKI fluctuated annually, peaking at 40 per 1000 person-years (PY) [95% confidence interval (CI) 22–69 per 1000 PY] in 2007, and reached a nadir of 20 per 1000 PY (95% CI 11–34 per 1000 PY) in 2010. There was no significant temporal trend (−3.3% change per year; 95% CI −8.6 to 2.3%; P = 0.24). After multivariable adjustment, characteristics independently associated with AKI included black race [hazard ratio (HR) 2.44; 95% CI 1.42–4.20], hypertension (HR 1.62; 95% CI 1.09–2.38), dipstick proteinuria > 1 (HR 1.86; 95% CI 1.07–3.23), a history of AIDS (HR 1.82; 95% CI 1.29–2.56), CD4 count < 200 cells/μL (HR 1.46; 95% CI 1.02–2.07), and lower serum albumin (HR 1.73 per 1 g/dL decrease; 95% CI 1.02–2.07).

Conclusions: In this contemporary cohort of PLWH, the annual incidence of first AKI fluctuated during the study period. Attention to modifiable AKI risk factors and social determinants of health may further reduce AKI incidence among PLWH.


Antiretroviral therapy (ART) has improved the life expectancy of people living with HIV (PLWH).[1,2] Unfortunately, noninfectious comorbidities including kidney diseases have tempered the improved longevity among PLWH.[3–5] Acute kidney injury (AKI) affects ~20% of hospitalized patients in the general population.[6,7] While the incidence of hospitalized AKI in the general population is rising,[6,7] few studies have described the epidemiology of AKI among PLWH in the era of universal ART.

Since the approval of zidovudine in 1987,[8] there have been more than two dozen drugs approved for HIV treatment.[9] Furthermore, newer ART regimens are associated with less nephrotoxicity compared with older ART.[10] However, prior AKI studies included PLWH on older more nephrotoxic agents or untreated PLWH.[11–15] Furthermore, some of these studies relied on administrative data to define AKI,[13] which have low sensitivity in detecting AKI.[16] Given the rapid evolution in ART and changing treatment guidelines over time, we quantified the longitudinal trends in AKI over a decade spanning 2005–2015 and evaluated risk factors for AKI among PLWH.