Background
Young people living with HIV (YPLHIV) are at increased risk of developing kidney abnormalities due to antiretroviral therapy (ART), particularly tenofovir disoproxil fumarate (TDF). Dolutegravir (DTG) is associated with increased creatinine levels. We explored the association of dolutegravir ART regimens with kidney abnormalities among YPLHIV in Kampala, Uganda.
Methods
We performed a cross-sectional study with YPLHIV aged 10-24 years in seven HIV clinics in Kampala. We collected a single urine and blood sample and measured the albumin creatinine ratio (ACR), proteinuria on dipstick, and estimated glomerular filtration rate (eGFR) using CKDEPI2021 equation (for ≥18 years) or bedside Schwartz (<18 years). Chi-square tests were used to compare kidney function parameters of those on TDF/DTG vs DTG combined with either zidovudine or abacavir (other regimens).
Results
A total of 483 participants were enrolled, of whom 58% were female and 69% were aged 10-17 years. The median duration on ART was 9.6 years (IQR 8,12). Among the 357 (78%) participants on both TDF and TDG, the mean BMI was higher than those on other regimens (20.7 vs 18.7; p<0.001) as was mid-upper arm circumference (25.5 vs 22.5;p <0.001) and mean serum creatine (0.67 vs 0.59; p<0.001). The mean cystatin C level was normal and comparable in both groups. The mean eGFR was within normal limits and lower among those on TDF/DTG compared to those on other regimens (132.3ml/min/1.73m2 vs 142.1ml/min/1.73m2; p<0.001). The eGFR according to cystatin C was comparable in both groups (114.2 ml/min/1.73;m2 vs 116.5ml/min/1.73m2; p=0.15). The proportion of participants with ACR>30mg/g and proteinuria were comparable by treatment regimen (9.6% vs 13.0% p=0.30; 28.3% vs 30.2%, p=0.70).
Conclusions
Abnormal ACR and proteinuria are prevalent among YPLHIV in Kampala, Uganda, and similar by ART regimen. While kidney function was largely within normal limits except creatinine which was higher among those on TDF/DTG, these findings raise concern. Longer-term follow-up is needed to understand whether YPLHIV on ART will develop chronic kidney disease as they age, and to elucidate risk factors for kidney disease progression that may be modifiable.