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, 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

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.

Conflict of interest statement

Dr Hung has nothing to disclose. Dr Santana-Suarez has nothing to disclose. Dr Binns-Roemer has nothing to disclose. Dr Campbell has nothing to disclose. Dr Bramham has nothing to disclose. Dr Hamzah has nothing to disclose. Dr Fox has nothing to disclose. Dr Burns has nothing to disclose. Dr Clarke reports personal fees from Advisory boards & conference travel from Gilead Sciences, personal fees from Advisory boards from ViiV Healthcare, outside the submitted work. Dr Vincent has nothing to disclose. Dr Jones has nothing to disclose. Dr Price has nothing to disclose. Dr Onyago has nothing to disclose. Dr Harber has nothing to disclose. Dr Hilton has nothing to disclose. Dr Booth has nothing to disclose. Dr Sabin has nothing to disclose. Dr Winkler has nothing to disclose. Dr Post reports grants from Medical Research Council UK, grants, personal fees and non-financial support from Gilead, grants personal fees and non-financial support from ViiV, grants and personal fees from MSD, grants and personal fees from Janssen, during the conduct of the study.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Regions of sub-Saharan Africa (East, Central, West, South) and prevalence of renal impairment (eGFR 2) by region of ancestry of the study participants.
Fig. 2
Fig. 2
Proportion of participants with eGFR stages 1–5, by country of ancestry Proportion of participants in each country of ancestry with estimated glomerular filtration rate >90, 60–89, 30–59, 15–29 and 2. Data are restricted to participants with both parents born in the same country, and to countries with at least N = 10 individuals.

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