Impaired kidney function in People with HIV compared to People without HIV

The prevalence of impaired kidney function (eGFR < 60 ml/min/1.73 m2) is higher in people with HIV (PWH) compared to the general population. We aimed to quantify differences in estimated glomerular filtration rates (eGFR) between PWH and HIV-negative individuals in the French population-based CONSTANCES cohort, considering socioeconomic, lifestyle factors, and potentially nephrotoxic/eGFR-modifying drug exposure.

We analyzed baseline data (2012-2021) from the prospective French national cohort study CONSTANCES, including 220 000 participants aged 18-69. PWH were identified through linkage to the French National Health Data System (SNDS) and matched 1 : 4 with same-sex HIV-negative people.

Missing data were handled using multiple imputation by chained equations. eGFR levels were compared by HIV status using linear regression models. Multivariable models were adjusted for sociodemographic, lifestyle factors, and potentially nephrotoxic/eGFR-modifying drug exposure.

The study population included 2195 men (439 PWH, 1756 HIV-negative) and 365 women (73 PWH, 292 HIV-negative). PWH had lower education levels, belonged to lower socio-professional categories, and reported more often high-risk substance use than HIV-negative people. In both sexes, living with HIV was associated with lower kidney function. In men, the mean difference in eGFR levels was -7.1 ml/min/1.73 m2, 95% confidence interval (CI) [-8.6 ml/min/1.73 m2; -5.6 ml/min/1.73 m2] in the fully adjusted model (P < 0.001). In women, it was -4.9 ml/min/1.73 m2, 95% CI [-8.8 ml/min/1.73 m2; -0.9 ml/min/1.73 m2] (P = 0.02). The prevalence of impaired kidney function was 5.6% in PWH vs. 1.0% in HIV-negative people, adjusted odds ratio (OR) = 4.9, 95% CI [2.5-9.7].

Living with HIV is associated with lower eGFR levels after comprehensive adjustment for many confounders. Our findings emphasize the need for regular kidney function assessments and reducing the use of nephrotoxic drugs among PWH.