The epidemiology of kidney disease in people of African ancestry with HIV in the UK

Rachel K Y Hung; Beatriz Santana-Suarez; Elizabeth Binns-Roemer; Lucy Campbell; Kate Bramham; Lisa Hamzah; Julie Fox; James E Burns; Amanda Clarke; Rachel Vincent; Rachael Jones; David A Price; Denis Onyango; Mark Harber; Rachel Hilton; John W Booth; Caroline A Sabin; Cheryl A Winkler; Frank A Post; GEN-AFRICA study group

doi:10.1016/j.eclinm.2021.101006

The epidemiology of kidney disease in people of African ancestry with HIV in the UK

EClinicalMedicine. 2021 Jul 8:38:101006. doi: 10.1016/j.eclinm.2021.101006. eCollection 2021 Aug.

Authors

Rachel K Y Hung¹, Beatriz Santana-Suarez¹, Elizabeth Binns-Roemer², Lucy Campbell¹, Kate Bramham^{1

3}, Lisa Hamzah⁴, Julie Fox^{1

5}, James E Burns^{6

7}, Amanda Clarke^{8

9}, Rachel Vincent¹⁰, Rachael Jones¹¹, David A Price¹², Denis Onyango¹³, Mark Harber¹⁴, Rachel Hilton⁵, John W Booth¹⁵, Caroline A Sabin⁶, Cheryl A Winkler², Frank A Post^{1

3}; GEN-AFRICA study group

Affiliations

¹ King's College London, King's College Hospital, NHS Foundation Trust, Weston Education Center (Rm 2.50), Cutcombe Road, London SE5 9RJ, UK.
² Basic Research Laboratory, Frederick National Laboratory for Cancer Research and the National Cancer Institute, Frederick, USA.
³ King's College Hospital NHS Foundation Trust, London, UK.
⁴ St George's Hospital NHS Foundation Trust, London, UK.
⁵ Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁶ University College London, London, UK.
⁷ Central and North West London NHS Foundation Trust, London, UK.
⁸ Brighton and Sussex University Hospital NHS Trust, Brighton, UK.
⁹ Brighton and Sussex Medical School Department of Infectious Disease, Brighton, UK.
¹⁰ North Middlesex University Hospital NHS Trust, London, UK.
¹¹ Chelsea and Westminster Hospital NHS Trust, London, UK.
¹² The Newcastle Upon Tyne Hospitals, Newcastle, UK.
¹³ Africa Advocacy Foundation, UK.
¹⁴ Royal Free London Hospital NHS Foundation Trust, London, UK.
¹⁵ Barts Health NHS Trust, London, UK.

Abstract

Background: Chronic kidney disease (CKD) is a leading cause of morbidity and mortality globally. The risk of CKD is increased in people of African ancestry and with Human Immunodeficiency Virus (HIV) infection.

Methods: We conducted a cross-sectional study investigating the relationship between region of ancestry (East, Central, South or West Africa) and kidney disease in people of sub-Saharan African ancestry with HIV in the UK between May 2018 and February 2020. The primary outcome was renal impairment (estimated glomerular filtration rate [eGFR] of <60 mL/min/1.73 m²). Secondary outcomes were stage 5 CKD (eGFR <15 ml/min/1.73 m², on dialysis for over 3 months or who had received a kidney transplant), proteinuria (urine protein/creatinine ratio >50 mg/mmol), and biopsy-confirmed HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS) or arterionephrosclerosis. Multivariable robust Poisson regression estimated the effect of region of African ancestry on kidney disease outcomes.

Findings: Of the 2468 participants (mean age 48.1 [SD 9.8] years, 62% female), 193 had renal impairment, 87 stage 5 CKD, 126 proteinuria, and 43 HIVAN/FSGS or arterionephrosclerosis. After adjusting for demographic characteristics, HIV and several CKD risk factors and with East African ancestry as referent, West African ancestry was associated with renal impairment (prevalence ratio [PR] 2.06 [95% CI 1.40-3.04]) and stage 5 CKD (PR 2.23 [1.23-4.04]), but not with proteinuria (PR 1.27 [0.78-2.05]). West African ancestry (as compared to East/South African ancestry) was also strongly associated with a diagnosis of HIVAN/FSGS or arterionephrosclerosis on kidney biopsy (PR 6.44 [2.42-17.14]).

Interpretation: Our results indicate that people of West African ancestry with HIV are at increased risk of kidney disease. Although we cannot rule out the possibility of residual confounding, geographical region of origin appears to be a strong independent risk factor for CKD as the association did not appear to be explained by several demographic, HIV or renal risk factors.

Keywords: Africa; Apolipoprotein L1; Chronic kidney disease; Diaspora; Epidemiology; HIV; HIVAN.

Grants and funding

MC_PC_17164/MRC_/Medical Research Council/United Kingdom