Prevalence of impaired renal function in virologically suppressed people living with HIV compared with controls: the Copenhagen Comorbidity in HIV Infection (COCOMO) study*

Abstract

Objectives While renal impairment is reported more frequently in people living with HIV (PLWH) than in the general population, the PLWH samples in previous studies have generally been dominated by those at high renal risk. Methods Caucasian PLWH who were virologically suppressed on antiretroviral treatment and did not have injecting drug use or hepatitis C were recruited from the Copenhagen Comorbidity in HIV Infection (COCOMO) study. Sex‐ and age‐matched controls were recruited 1:4 from the Copenhagen General Population Study up to November 2016. We defined renal impairment as one measurement of estimated glomerular filtration rate ≤ 60 mL/min/1.73 m2, and assessed associated factors using adjusted logistic regression models. The impact of HIV‐related factors was explored in a subanalysis. Results Among 598 PLWH and 2598 controls, the prevalence of renal impairment was 3.7% [95% confidence interval (CI) 2.3–5.5%] and 1.7% (95% CI 1.2–2.2%; P = 0.0014), respectively. After adjustment, HIV status was independently associated with renal impairment [odds ratio (OR) 3.4; 95% CI 1.8–6.3]. In addition, older age [OR 5.4 (95% CI 3.9–7.5) per 10 years], female sex [OR 5.0 (95% CI 2.6–9.8)] and diabetes [OR 2.9 (95% CI 1.3–6.7)] were strongly associated with renal impairment. The association between HIV status and renal impairment became stronger with older age (P = 0.02 for interaction). Current and nadir CD4 counts, duration of HIV infection and previous AIDS‐defining diagnosis were not associated with renal impairment among virologically suppressed PLWH. Conclusions The prevalence of renal impairment is low among low‐risk virologically suppressed Caucasian PLWH, but remains significantly higher than in controls. Renal impairment therefore remains a concern in all PLWH and requires ongoing attention.

Interaction of sex and HIV infection on renal impairment: baseline evidence from the CHART cohort

“…A study conducted in Tanzania also showed that female PLWH initiating ART have higher risk of renal dysfunction (eGFR <60 ml/min/1.73m 2 ) (Msango et al, 2011); similar result was observed in PLWHIV in Denmark (Petersen et al, 2019). While female gender was significantly associated with mild renal impairment (RI) in PLWH in France (Déti et al, 2010).…”

“…Sex disparity in RI was observed in both PLWH and HIV-negative individuals (Carrero et al, 2018;Déti et al, 2010;Mocroft et al, 2015;Msango et al, 2011;Neugarten et al, 2019;Petersen et al, 2019). Available data in general population not only showed higher risk of CKD in female than in male that observed in PLWH, but also documented more rapid progression of kidney function decline in male than female in HIV-negative people (Carrero et al, 2018;Neugarten et al, 2019).…”

“…Previous studies have reported that sex difference exists in CKD for PLWH, and HIV-positive females are more vulnerable to CKD compared to HIV-positive males (Déti et al, 2010;Mocroft et al, 2015;Msango et al, 2011;Petersen et al, 2019) Female gender predicted the CKD in the D: A: D study well, and one point was assigned to being female in calculating the risk score for CKD (Mocroft et al, 2015).…”

A Step Closer to the “Fourth 90”: A Practical Narrative Review of Diagnosis and Management of Nutritional Issues of People Living with HIV

“…The Copenhagen Comorbidity in HIV Infection Study [92] has demonstrated that HIV infection is an independent risk factor for renal impairment development, probably because of chronic inflammation and coagulation activation induced by HIV infection. Furthermore, it showed that the risk of renal impairment was higher in older PLWH compared to younger PLWH [100]. In fact, the kidneys act as an HIV reservoir and the resulting polyclonal gammaglobulinemia, immune complex and cryoglobulin production, and glomerular injury are consequences of T-cell-dependent B response hy-peractivation.…”

Social Capital in Old People Living with HIV Is Associated with Quality of Life: A Cross-Sectional Study in China

“…The PLWH's quality of life (QoL), usually defined as an individual's overall perception of their physical state, psychological functions, social ability, and individual comprehensive conditions based on social economy, cultural background, and value orientation [10], is generally lower than that of the general population, due to HIV-related disabilities [6] and ongoing widespread stigma [11][12][13]. The old PLWH, compared to the young PLWH and the general old population, usually face a higher level of stigma [13,14], a high risk of comorbidity [15], more side effects from antiretroviral therapy (ART) [16], and less social support from friends or families [17]. Recent studies have examined the roles of interpersonal and social factors in the QoL among PLWH in China, revealing that social trust and social connection may be associated with a mental health summary (MCS) score of QoL [18].…”