1. Acute Renal Failure in HIV- Infected Individuals Greatly Increases Risk for In-Hospital Mortality Slideset on: Wyatt CM, Arons RR, Klotman PE, Klotman ME. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS. 2006;20:561-565.

2. clinicaloptions.com/hiv Acute Renal Failure in HIV Infection Increases In-Hospital Mortality Wyatt CM, et al. AIDS. 2006;20:561-565. Background and Rationale  Long-term complications of HAART now leading causes of death among HIV-infected individuals on HAART –Acute renal failure common among these individuals; associated with AIDS, HCV coinfection, and liver disease  In general population, acute renal failure strongly predicts morbidity and mortality in hospitalized patients  Current study compared incidence of acute renal failure in HIV-infected individuals in pre- and post-HAART eras, and association between acute renal failure and in- hospital mortality in post-HAART era

3. clinicaloptions.com/hiv Acute Renal Failure in HIV Infection Increases In-Hospital Mortality Wyatt CM, et al. AIDS. 2006;20:561-565. Summary of Study Design  Information on HIV-infected patients discharged from acute care hospitals in New York state during 1995 (pre- HAART era) and 2003 (post-HAART era) obtained from statewide database –Acute renal failure determined by diagnosis code 584 –In-hospital mortality determined  Other data collected: sex, age, diabetes, chronic kidney disease, primary diagnosis, acute or chronic liver disease, and hepatitis coinfection  Statistical analyses corrected for patient demographics, comorbid conditions, and primary diagnoses

4. clinicaloptions.com/hiv Acute Renal Failure in HIV Infection Increases In-Hospital Mortality Wyatt CM, et al. AIDS. 2006;20:561-565. Baseline Characteristics Characteristic Hospitalized HIV-Infected Adults 1995 (n = 52,580)2003 (n = 25,114) Mean age, yrs (SD)39.5 (± 8.4)44.2 (± 9.1) Male, n (%)69.561.6 Black, %43.149.0 Diabetes, %4.410.2 Kidney disease, %3.33.0 Hepatitis, %4.615.2 Cirrhosis, %3.75.1 Liver disease, %8.620.7 Acute liver failure, %0.30.4 Acute renal failure, %2.96.0 In-hospital mortality, %11.05.9  Comorbid diabetes, liver disease complications more common in 2003 than in 1995 (P <.001)

5. clinicaloptions.com/hiv Acute Renal Failure in HIV Infection Increases In-Hospital Mortality Wyatt CM, et al. AIDS. 2006;20:561-565.  In-hospital acute renal failure more common in HIV- infected vs HIV-uninfected patients in 1995 and 2003 –1995: 2.9% vs 1.0% –2003: 6.0% vs 2.7%  HIV-1 infection associated with increased risk of acute renal failure in 1995 and 2003 –1995 OR: 4.62 (95% CI: 4.30-4.95) –2003 OR: 2.82 (95% CI: 2.66-2.99) HIV Infection and Acute Renal Failure

6. clinicaloptions.com/hiv Acute Renal Failure in HIV Infection Increases In-Hospital Mortality Wyatt CM, et al. AIDS. 2006;20:561-565.  HIV-1 infection associated with increased risk of in- hospital mortality in 1995 and 2003 –1995 adjusted OR: 6.74 (95% CI: 6.48-7.01) –2003 adjusted OR: 2.96 (95% CI: 2.79-3.14)  Acute renal failure more common in post-HAART vs pre- HAART era (adjusted OR: 2.03; 95% CI: 1.86-2.18)  In-hospital mortality less common in post-HAART vs pre- HAART era (adjusted OR: 0.49 (95% CI: 0.46-0.52)  Traditional risk factors for renal disease associated with acute renal failure in HIV-infected patients HIV Infection, Acute Renal Failure, and In-Hospital Mortality

7. clinicaloptions.com/hiv Acute Renal Failure in HIV Infection Increases In-Hospital Mortality Wyatt CM, et al. AIDS. 2006;20:561-565. Key Conclusions  HIV-1 infection correlates with greater risk of acute renal failure and in-hospital mortality in both pre-HAART and post-HAART eras  In HAART era, HIV-infected patients with acute renal failure at ~ 6-fold greater risk of in-hospital mortality than those without acute renal failure  In HAART era, acute renal failure, in-hospital mortality for HIV-infected individuals strongly associated with chronic kidney disease and liver disease –Suggests greater need to treat chronic kidney disease, hepatitis coinfection in HIV-infected individuals