People with both HIV and kidney disease are not being treated appropriately for HIV, leading to greater death rates, say researchers of a new study published in Clinical Infectious Diseases.

Andy Choi, MD, of the department of medicine at San Francisco General Hospital, and his colleagues examined the medical records of 12,315 HIV-positive patients in the Veterans Affairs (VA) medical system who’d had at least one kidney function test. Eight and a half percent of those patients—a total of 1,041 people—were found to have chronic kidney disease (CKD). Compared with people with normal kidney function, people with CKD were more likely to be black and older, have lower CD4 counts, and have diabetes, heart complications, dementia, hepatitis C and AIDS.

Dr. Choi’s team found that people with CKD, who based on CD4 counts and other measures should have been on antiretroviral (ARV) treatment, were significantly less likely to receive this treatment than people with normal kidney function. In particular, people with the worst kidney function were 64 percent less likely than healthier patients to be receiving ARV treatment. Also, a significant percentage of people with CKD who did receive ARVs had not had their medication doses adjusted in accordance with recommendations for patients with kidney impairment. The researchers state that lack of ARV treatment may have been the cause of death for as many as a third of people with CKD who died.