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/1.73m2. 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 × 109/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/µL: HR = 0.53, 95%CI: 0.31, 0.93; 350-499 cells/µL: HR = 0.45, 95%CI: 0.26, 0.79; ≥500 cells/µL: HR = 0.33, 95%CI: 0.20, 0.56) compared to < 200 cells/µL 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.