Sickle Cell Trait and Kidney Disease in People of African Ancestry With HIV

Sickle cell trait (SCT) has been associated with chronic kidney disease (CKD) in African Americans, although evidence for its impact in Africans and people with HIV is currently lacking. We conducted a cross-sectional study investigating the association between SCT and kidney disease in people of African ancestry with HIV in the UK.

The primary outcome was estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m². Secondary outcomes were eGFR <90 ml/min per 1.73 m², end-stage kidney disease (ESKD; eGFR <15 ml/min per 1.73 m², chronic dialysis, or having received a kidney transplant), proteinuria (protein-to-creatinine ratio >50 mg/mmol), and albuminuria (albumin-to-creatinine ratio >3 mg/mmol). Multivariable logistic regression was used to estimate the associations between SCT and kidney disease outcomes.

A total of 2895 participants (mean age 48.1 [SD 10.3], 57.2% female) were included, of whom 335 (11.6%) had SCT and 352 (12.2%) had eGFR <60 ml/min per 1.73 m². After adjusting for demographic, HIV, and kidney risk factors including APOL1 high-risk genotype status, individuals with SCT were more likely to have eGFR <60 ml/min per 1.73 m² (odds ratio 1.62 [95% CI 1.14-2.32]), eGFR <90 ml/min per 1.73 m² (1.50 [1.14-1.97]), and albuminuria (1.50 [1.09-2.05]). Stratified by APOL1 status, significant associations between SCT and GFR <60 ml/min per 1.73 m², eGFR <90 ml/min per 1.73 m², proteinuria, and albuminuria were observed for those with APOL1 low-risk genotypes.

Our results extend previously reported associations between SCT and kidney disease to people with HIV. In people of African ancestry with HIV, these associations were largely restricted to those with APOL1 low-risk genotypes.