Positive HIV status increases risk for proteinuria in men with prediabetes

The incidence of proteinuria in men with prediabetes is higher among those with HIV infection, according to study findings published in Clinical Infectious Diseases.

Researchers conducted a study to evaluate whether proteinuria incidence differs by HIV serostatus among men with prediabetes. Data were sourced between 2016 and 2019 from a total of 1276 men with prediabetes and no prevalent proteinuria or reported use of antidiabetic medications. Prediabetes was defined as a fasting glucose level of 100 to 125 mg/dL, recorded at baseline and confirmed within 1 year, or an HbA_1c of 5.7% to 6.4%. Proteinuria was defined as a protein-to-creatinine ratio above 200 mg/g at baseline and confirmed within 1 year. Poisson regression was used to assess the relationship between incident proteinuria and HIV serostatus and identify specific HIV-related risk factors.

The final analysis included 613 men with and 664 men without HIV infection, of whom the median age was 49.5 (IQR, 43.9-55.6) and 53.7 (IQR, 47.3-59.9) years, the median BMI was 25.7 (IQR, 23.3-28.8) and 27.2 (IQR, 24.4-30.3) kg/m², 48% and 27% were of non-White race/ethnicity, and 7% and 4% had hepatitis C virus (HCV) infection, respectively (all P <.01).

During a median follow-up period of 10 years, 128 (21%) patients with HIV infection and 50 (8%) without HIV infection developed proteinuria.

In the multivariate analysis, positive HIV status was associated with a 3.3-fold increased risk for proteinuria (P <.01). Additional predictors of incident proteinuria included lower estimated glomerular filtration rate (<60 vs >90 mL/min/1.73 m²; incidence rate ratio [IRR], 3.5; 95% CI, 2.0-6.2), HCV infection (IRR, 2.1; 95% CI, 1.2-3.9), hypertension (IRR, 2.0; 95% CI, 1.4-2.7), and cigarette smoking (IRR, 1.7; 95% CI, 1.1-2.7).

Among HIV-positive patients, incident proteinuria was associated with use of integrase strand transfer inhibitors (INSTIs; IRR, 0.5; 95% CI, 0.3-0.9; P ≤.01), as well as cumulative 5-year use of INSTIs (IRR, 0.5; 95% CI, 0.3-1.0; P =.03), lamivudine (IRR, 0.8; 95% CI, 0.7-1.0; P =.04), and amprenavir (IRR, 3.3; 95% CI, 1.1-9.4; P =.03).

Similar results were observed in sensitivity analyses that were adjusted for waist and hip circumference and use of non-HIV medications. Multivariate models that excluded patients who developed diabetes during the follow-up period or restricted the population to self-identified Black patients also showed similar findings.

Study limitations include the lack of glucose tolerance testing and the absence of women.

“Our findings suggest the need for implementation of early screening and prevention strategies among men living with HIV and pre-[diabetes] in order to reduce the risk of incident proteinuria and long-term kidney disease,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Jessica Nye, PhD

References:

Slama L, Barrett BW, Abraham AG, et al; for the Multicenter AIDS Cohort Study (MACS). Incident proteinuria differs by HIV serostatus among men with pre-diabetes: the multicenter AIDS cohort study. Clin Infect Dis. Published online February 9, 2024. doi:10.1093/cid/ciae065