Using data from the VACS Virtual Cohort, the investigators identified 31,072 U.S. veterans who had a baseline estimated glomerular filtration rate (eGFR) 45 mL/minute/1.73m2 (mean, 94 mL/minute/1.73m2). About 34% of the veterans had HIV infection alone, 16% had diabetes alone, and 6% had both. The primary endpoint was a decrease in eGFR toDuring a median follow-up of 5 years, the proportion of study participants who reached the eGFR endpoint varied dramatically by HIV and diabetes status: 4% among those without either condition, 8% among those with HIV only, 12% among those with diabetes only, and 18% among those with both.

After adjustment for traditional CKD risk factors, HIV and diabetes each remained significant predictors of CKD (hazard ratio, 2.8 and 2.5), but the greatest risk was seen with the two factors combined (HR, 4.5). When the analysis was limited to HIV-infected veterans, diabetes remained an independent predictor of CKD progression, and similarly, when the analysis was limited to veterans with diabetes, HIV infection remained a significant predictor.

Comment: Not surprisingly, HIV infection and diabetes each contribute individually to progression of CKD, and the presence of both conditions together has a particularly detrimental effect on renal function.

Although many factors that contribute to CKD progression in the HIV-infected population are not modifiable, the development and control of diabetes is — and should be aggressively addressed by HIV providers.

HIV-infected patients who already have diabetes should be followed closely and screened regularly for evidence of declining renal function.

— Sonia Nagy Chimienti, MD Published inJournal Watch HIV/AIDS Clinical CareAugust 6, 2012