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Background  Serum creatinine and cystatin C are used as markers of glomerular filtration rate (GFR). The performance of these GFR markers relative to exogenously measured GFR (mGFR) in HIV-positive individuals is not well established.    Methods  We assessed the performance of the chronic kidney disease epidemiology collaboration equations based on serum concentrations of creatinine (eGFR cr ), cystatin C (eGFR cys ) and both biomarkers combined (eGFR cr-cys ) in 187 HIV-positive and 98 HIV-negative participants. Measured GFR was calculated by plasma iohexol clearance. Bias and accuracy were defined as the difference between eGFR and mGFR and the percentage of eGFR observations within 30% of mGFR, respectively. Activated CD4 and CD8 T-cells (CD38+ HLA-DR+) were measured by flow cytometry.    Results  The median mGFR was >100 ml/min/1.73 m 2  in both groups. All equations tended to be less accurate in HIV-positive than in HIV-negative subjects, with eGFR cr-cys  being the most accurate overall. In the HIV-positive group, eGFR cys  was significantly less accurate and more biased than eGFR cr  and eGFR cr_cys . Additionally eGFR cys  bias and accuracy were strongly associated with use of antiretroviral therapy, HIV RNA suppression, and percentages of activated CD4 or CD8 T-cells. Hepatitis C seropositivity was associated with larger eGFR cys  bias in both HIV-positive and HIV-negative groups. In contrast, eGFR cr  accuracy and bias were not associated with HIV-related factors, T-cell activation, or hepatitis C.    Conclusions  The performance of eGFR cys  relative to mGFR was strongly correlated with HIV treatment factors and markers of T-cell activation, which may limit its usefulness as a GFR marker in this population.

HIV Viremia and T-Cell Activation Differentially Affect the Performance of Glomerular Filtration Rate Equations Based on Creatinine and Cystatin C