Kidney function impairment among older people living with and without HIV at the Infectious Diseases Institute Clinic-Mulago, Kampala , Uganda

Abstract

The use of antiretroviral therapy (ART) has averted at least 20 million human immunodeficiency virus (HIV)-related deaths over the last two decades allowing people living with HIV (PLWH) to age. However, HIV-associated chronic inflammation and long life use of ART increases risk of non-communicable diseases (NCDs) including chronic kidney disease (CKD). Moreover, aging-related nephron senescence leads to kidney function decline. Consequently, older PLWH may experience a higher burden of kidney function impairment than older people without HIV. Among PLWH, CKD has been associated with an increased hazard of death. Despite this, there is limited data on the kidney health of older PLWH in Uganda and other low-income regions in sub-Saharan Africa, leading to potential gaps in routine kidney function monitoring.We aimed to compare the burden of kidney function impairment and associated factors between older people aged ≥60 years living with and without HIV at the Infectious Diseases Institute (IDI) clinic-Mulago, Kampala. Methods: We conducted a cross-sectional study between April and August 2023 among older people aged ≥60 years living with and without HIV at IDI clinic, Mulago. We collected data using an interviewer-administered questionnaire and obtained blood and urine samples from each participant for creatinine and urine protein measurements, respectively. We compared the burden of kidney function impairment between PLWH and people without HIV using the chi-square statistic. We constructed multivariable log binomial models to study factors associated with kidney function impairment. Results: Among 278 old people aged ≥60 years, median age 66 years, 50% were PLWH, 51.8% were female and 23.0% (95% CI:18.1-28.0) had kidney function impairment. Among Older PLWH 32.4% (95%confidence interval: 25.1%-40.6%) had kidney function impairment compared to 12.9% (95%confidence interval: 8.3%-19.7%) among older people without HIV, p-value<0.01. Proteinuria was present among 43.9% (95%confidence interval: 35.8%-52.3%) older PLWH versus 19.4% (95%confidence interval: 13.6%-26.9%) in older people without HIV, p-value<0.01. Older age (PR=1.1, (95% CI: 1.06-1.20), p-value<0.01), being female (PR=1.6, (95% CI: 1.05-2.37), p-value=0.03) and living with HIV (PR=2.72, (95% CI: 1.71-4.34), p<0.01) were associated with kidney function impairment. Conclusion: Our findings highlight the higher burden of kidney impairment among older PLWH, driven by age, HIV status, and gender. There is urgent need for targeted interventions to detect and prevent CKD and its progression in older PLWH in Uganda and similar settings.