Impaired Kidney Function in People Living with HIV, Taking into Account Socioeconomic Factors, Lifestyle, and Nephrotoxic Drugs: Population-Based CONSTANCES Cohort
Résumé
Background: The prevalence of impaired kidney function (eGFR<60mL/min/1·73m2) is higher in People Living with HIV (PLHIV) compared to the general population. We aimed to quantify differences in estimated glomerular filtration rates (eGFR) between PLHIV and HIV-negative individuals in the French population-based CONSTANCES cohort, considering socioeconomic and lifestyle factors, HIV-related history, and potentially nephrotoxic/eGFR-modifying drug use. Methods: We analyzed baseline data (2012-2021) from the prospective French national cohort study CONSTANCES (questionnaire data, medical examination results, and healthcare utilization data from the national medico-administrative database SNDS), including 220,000 participants aged 18-69. PLHIV were identified through linkage to the SNDS and 1:4 matched with same-sex HIV-negative people, on age, year of enrollment, examination center, Sub-Saharan African origin, and sexual orientation (in men). Missing data were handled using multiple imputation by chained equations, separately by sex. eGFR levels were compared by HIV status using linear regression models in each imputed dataset. Multivariable models were adjusted for sociodemographic and lifestyle factors, and treatment with potentially nephrotoxic/eGFR-modifying drugs. Results: The study population included 2,195 men (439 PLHIV, 1,756 HIV-negative) and 365 women (73 PLHIV, 292 HIV-negative). PLHIV 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 -7·0mL/min/1·73m2, 95%CI[-8·5mL/min/1·73m2; -5·5mL/min/1·73m2] in the fully adjusted model (p<0·0001). In women, it was -4·9mL/min/1·73m2, 95%CI[-8·8mL/min/1·73m2; -0·9mL/min/1·73m2] (p=0·015). Overall, the prevalence of impaired kidney function was 5·6% in PLHIV vs. 1·0% in HIV-negative people, adjusted OR=5·0, 95%CI[2·5-9·9]. Interpretation: 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 for reducing the use of nephrotoxic drugs among PLHIV.
| Origine | Fichiers produits par l'(les) auteur(s) |
|---|---|
| licence |
