Kidney dysfunction in adults living with HIV and HBV: a 10-year retrospective cohort study across seven Asia-Pacific countries

Abstract

Background This study investigated kidney dysfunction among people with HIV (PWH), comparing those with and without hepatitis B virus (HBV) co-infection. We further identified predictors of kidney dysfunction in PWH with HBV. Methods Adult PWH in the TREAT Asia Observational Database-Low Intensity TransfEr cohort, who were on antiretroviral therapy, with follow-up after 2010 were included. HBV co-infection was defined by positive hepatitis B surface antigen. Kidney dysfunction was determined as a single estimated glomerular filtration rate < 60mL/min/1.73m(2). Kaplan-Meier curves were used to evaluate cumulative incidence of kidney dysfunction, and we used Cox proportional hazards model to analyze factors associated with kidney dysfunction in PWH with HBV. Results Among 23,415 participants (median age = 37 years; interquartile range [IQR]: 31-43), most were male (62.2%), from lower-middle income countries (67.1%), and reported heterosexual HIV transmission (79.3%). The median follow-up time was 5.41 years (IQR: 2.05-8.67). The majority were prescribed NRTI + NNRTI (83.6%), and 4.9% had HBV co-infection. Overall, 8.0% had kidney dysfunction, with a higher proportion among PWH with HBV than those without HBV (14.8% vs. 7.6%, p < 0.001). Most cases of kidney dysfunction were stage III (84.2%). Factors associated with kidney dysfunction in PWH with HBV included older age (>= 50 years: Hazard ratio [HR] = 6.45, 95%CI: 2.31, 18.04) compared to 18-29 years, higher income country (upper-middle income: HR = 1.78, 95%CI: 1.16, 2.74) compared to lower-middle income, low platelet counts (< 150 x 10(9)/L: HR = 2.82, 95%CI: 1.85, 4.31) compared to normal platelets, and ART regimens (NRTI + NNRTI: HR = 0.43, 95%CI: 0.27, 0.70; NRTI + PI: HR = 0.60, 95%CI: 0.36, 1.01) compared to NRTI + INSTI. Higher CD4 counts (200-349 cells/<mu>L: HR = 0.53, 95%CI: 0.31, 0.93; 350-499 cells/mu L: HR = 0.45, 95%CI: 0.26, 0.79; >= 500 cells/mu L: HR = 0.33, 95%CI: 0.20, 0.56) compared to < 200 cells/<mu>L were associated with lower risk of renal dysfunction. There was no significant difference in kidney dysfunction between those on TDF and TAF (HR = 0.55, 95%CI: 0.25, 1.23). Conclusions A high prevalence of kidney dysfunction was observed among PWH with HBV co-infection in the Asia-Pacific. Renal screening and monitoring should prioritize PWH with HBV with older age, low platelets and CD4 counts in low-resource settings.