Features of comorbidity of chronic heart failure and chronic kidney disease in patients infected with the human immunodeficiency virus

THE AIM OF THE STUDY: to identify risk factors associated with the course of chronic kidney disease (CKD), as the main manifestation of damage to the target organ – the kidney, in patients with chronic heart failure (CHF) infected with the human immunodeficiency virus (HIV).

PATIENTS AND METHODS. In a multidisciplinary hospital for 28 months in 2019-2022, a one-stage screening clinical study was conducted, which included 240 patients with HIV infection. Of these, 160 people were diagnosed with CHF. Depending on the presence of CKD with a glomerular filtration rate (GFR) <60 mm/min/m2, patients with CHF were divided into 2 groups. The first group consisted of patients with CKD (46 people), and the second group – without signs of CKD (114 people). All patients within the framework of the study underwent the determination of cystatin C in blood serum, the Nterminal fragment of the brain natriuretic peptide (NT-proBNP) in blood plasma, C-reactive protein (CRP) in blood serum, and the quantitative determination of protein in urine.

RESULTS. The prevalence of CKD among patients with CHF and HIV infection is 58.82 %, which is 4 times more common than in patients with HIV infection without CHF. Risk factors for the development of CKD in patients with CHF and HIV infection are smoking, alcohol and drug use, a history of chronic and acute forms of coronary artery disease, atrial fibrillation, ventricular arrhythmias, diabetes mellitus, chronic viral hepatitis C, anemia, and thrombocytopenia. Patients with CHF and CKD have a more rigid arterial wall – there is a significant excess of the stiffness indices of the aorta and peripheral arteries. Long-term use of antiplatelet agents and antiretroviral therapy aggravates the course of CHF in HIV-infected people with CKD manifestations. The concentration of NT-proBNP in the blood plasma of patients with CHF equal to or greater than 683.65 pg/ml can be considered as a diagnostic criterion for the development of CKD in HIV-infected people with a sensitivity of the method of 75.0 % and a specificity of 75.4 %, respectively. It has been proven that GFR depends on three main factors that reflect damage to the heart muscle – the concentration of NT-proBNP in blood plasma, the values of LVEF % and LVMI, which together, being included in the regression model, determine 42.2 % of the dispersion of GFR values and are decisive in the development of CKD in patients with CHF on the background of HIV infection.

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