Predictors of adverse outcome in patients with HIV infection and kidney involvement

Abstract

The purpose — to determine predictors of adverse outcome in patients with HIV infection and kidney damage. Material and methods. A retrospective comparative study of 1,787 autopsy records from Infectious Clinical Hospital No. 2, Moscow (2021–2023) included epidemiological, clinical, and laboratory parameters of patients with confirmed HIV infection and renal involvement. The main group comprised 239 patients with confirmed renal involvement and fatal outcome. The comparison group included patients with established renal involvement without fatal outcome (n = 56). We assessed biochemical, hematological, immunological parameters, and systemic inflammation indices. Results. Arterial hypertension was significantly more prevalent in the deceased group (57.3 vs. 23.2%; p < 0.001). The median CD4⁺ lymphocyte count in the deceased group was significantly lower: 35 [8; 103] vs. 162 [47; 311] cells/µL (p < 0.001). High viral load (HIV RNA >100,000 copies/mL) was also significantly more frequent in the deceased group — 87.9 vs. 53.6% (p < 0.001). The median serum albumin level in the deceased group was 26.0 [21.9; 31.9] vs. 36.3 [29.8; 41.9] g/L (p < 0.001). No statistically significant between-group differences in eGFR were detected (79.6 [37.5; 110.8] vs. 82.0 [39.5; 101.5] mL/min/1.73 m²; p = 0.895). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were significantly higher in the deceased group compared to the non-fatal outcome group (p < 0.001; p = 0.008; p < 0.001, respectively). Multivariate analysis identified four independent predictors of fatal outcome: high HIV RNA viral load (aOR = 8.73; 95% CI 3.10–24.57; p < 0.001), decreased CD4⁺ lymphocyte count (each reduction of 10 cells/µL was associated with a 10.5% increase in the risk of fatal outcome) (aOR = 0.99; 95% CI 0.98–0.99; p < 0.001), arterial hypertension (aOR = 4.40; 95% CI 1.51–12.87; p = 0.007), and hypoalbuminemia (aOR = 0.90; 95% CI 0.85–0.94 per 1 g/L decrease; p < 0.001). The prognostic model demonstrated high discriminatory ability (AUC-ROC = 0.918; 95% CI 0.856–0.964; p < 0.001). Conclusion. Independent predictors of adverse outcomes in patients with HIV infection and renal involvement are high viremia, profound immunosuppression, hypoalbuminemia, and arterial hypertension. The findings highlight the importance of timely initiation of antiretroviral therapy, management of arterial hypertension, and regular monitoring of nutritional status in HIV patients with renal involvement to reduce the risk of adverse outcomes.