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Published ahead of print on October 17, 2007
Clin J Am Soc Nephrol 2: 1125-1130, 2007
© 2007 American Society of Nephrology
doi: 10.2215/CJN.02450607
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Clinical Nephrology

Cocaine Use and Hypertensive Renal Changes in HIV-Infected Individuals

Derek M. Fine*, Neha Garg{dagger}, Mark Haas{ddagger}, M. Hafizur Rahman*,§, Gregory M. Lucas*, Paul J. Scheel*, and Mohamed G. Atta*

Departments of * Medicine and {ddagger} Pathology, Johns Hopkins School of Medicine and the Johns Hopkins Hospital, and § Department of International Health, Division of Health Systems, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland; and {dagger} Department of Medicine, All India Institute of Medical Sciences, New Delhi, India

Correspondence: Dr. Mohamed G. Atta, 1830 E. Monument Street, Suite 416, Baltimore, MD 21287. Phone: 410-955-5268; Fax: 410-955-0485; E-mail: matta1{at}jhmi.edu

Background and objectives: Cocaine causes kidney damage, but data linking cocaine use to chronic kidney disease in HIV patients is not described. This study was conducted to evaluate the possible association of cocaine use and histopathologic findings on biopsy in this population.

Design, setting, participants, & measurements: Kidney biopsies that were performed in HIV-infected patients during the course of 11 yr were reviewed. Demographic and clinical data were collected. Hypertensive changes were defined on the basis of the Banff 97 classification. Criteria of both arterial intimal fibrosis and thickening and hyaline arteriolosclerosis were used and graded as absent (0), mild (1), moderate (2), and severe (3). Hypertensive renal changes were considered present when the combined pathology score was ≥2. To minimize confounding, those with hypertension or diabetes were excluded.

Results: Of the 193 HIV patients who underwent kidney biopsy, 53 had no history of hypertension or diabetes with HIV infection. Of those, 29 (55%) had hypertensive renal changes on kidney biopsy. Cocaine use was present in 16 (55%) of 29 with hypertensive renal changes compared with six (25%) of 24 without hypertensive renal changes (odds ratio [OR] 3.7; 95% confidence interval [CI] 1.2 to 11.7). In the adjusted analyses, only age (/yr; OR 1.08; 95% CI 1.00 to 1.16) and cocaine use (OR 3.55; 95% CI 1.04 to 12.14) were significantly associated with hypertensive renal changes on renal biopsy.

Conclusions: Cocaine use is associated with hypertensive renal changes in HIV-infected patients in the absence of hypertension and diabetes.






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