Risk factors of renal dysfunction in patients with herpes simplex virus 2/human immunodeficiency virus-1 co-infection

Objective To explore the effects of herpes simplex virus 2 (HSV-2) co-infection on the renal function in human immunodeficiency virus-1 (HIV-1) infected patients, and to screen the risk factors of renal dysfunction. Methods A total of 302 HIV-1-infected patients were included at The Eighth People's Hospital of Guangzhou from October 2011 to February 2014, which were divided into two groups: HIV(+ )HSV(+ ) group and HIV(+ )HSV(-) group. At the same time, 143 patients with HIV(-)HSV(+ ) were included as controls. The measurements of renal function were tested and compared among groups. Pearson correlation analysis was used to explore the relationship between HSV-2 DNA level and the severity of renal dysfunction. Multivariate Logistic regression analysis was used to determine the risk factors of renal dysfunction. Results There were 128 cases in HIV-1(+ )HSV-2(+ ) group, 174 in HIV-1(+ )HSV-2(-) group and 143 in HIV-1(-)HSV-2(+ ). Compared to HIV(-)HSV(+ ) group, the level of serum creatinine (F=14.37, P<0.01), BUN (F=12.54, P<0.01), 24 h urine protein (F=16.58, P<0.01) and urine protein/creatinine ratio (F=6.37, P=0.018) in both HIV(+ )HSV(+ ) group and HIV(+ )HSV(-) group were significantly increased, while estimated glomerular filtration rate (eGFR) in these two groups were significantly decreased (F=11.96, P<0.01). Meanwhile, compared to HIV(+ )HSV(-) group, HIV-1 RNA level (t=5.876, P<0.01), serum creatinine (t=2.315, P=0.012), 24 h urine protein (t=3.648, P=0.004), and urine protein/creatinine ratio (t=2.312, P=0.012) in HIV(+ )HSV(+ ) group were significantly increased, while CD4+ T lymphocyte counts (t=4.903, P<0.01) and eGFR (t=2.275, P=0.016) were significantly decreased. Pearson correlation analysis indicated that HSV-2 DNA level was positively correlated with HIV-1 RNA level (r=0.626, P=0.002), serum creatinine level(r=0.798, P<0.01), 24 h urine protein level (r=0.702, P<0.01), and urine protein/creatinine ratio (r=0.686, P<0.01), whereas negatively correlated with CD4+ T lymphocyte counts (r=-0.796, P<0.01) and eGFR (r=-0.656, P<0.01). Multivariate Logistic regression analysis showed that HSV-2 DNA level (odds ratio [OR]=1.166, P=0.021), HIV-1 RNA level (OR=1.581, P<0.01), CD4+ T lymphocyte counts<200/μL (OR=1.762, P<0.01), age (OR=1.472, P<0.01), ≥1 complication (OR=1.062, P=0.032), and glycosylated hemoglobin level (OR=1.124, P=0.015) were independent risk factors of renal dysfunction. Conclusions HSV-2 co-infection might aggravate the renal dysfunction of HIV-1 patients, and HSV-2 DNA level might be one of the potential risk factors of renal dysfunction. Key words: HIV-1; Herpesvirus 2, human; Renal insufficiency; AIDS-associated nephropathy