As individuals living with HIV experience increased longevity thanks to modern antiretroviral therapies, managing co-occurring conditions like hepatitis B is becoming increasingly critical. New research published in AIDS Research and Therapy reveals a significantly elevated risk of kidney failure among those co-infected with HIV and hepatitis B – nearly double that of individuals with HIV alone. A study of over 23,000 individuals in the Asia-Pacific region identified specific risk factors and potential impacts from different antiretroviral regimens, highlighting the need for targeted kidney health monitoring in this vulnerable population.
L’ESSENTIEL
- In a recent study, 14.8% of individuals living with both HIV and hepatitis B developed kidney failure.
- This is nearly double the 7.6% rate observed in adults not co-infected with hepatitis B.
- Factors associated with an increased risk of kidney failure in co-infected patients include older age, low platelet and CD4 counts, and residing in an upper-middle-income country.
People living with HIV and hepatitis B may face a significantly higher risk of kidney failure, according to new research. The study highlights the importance of monitoring kidney health in individuals with these co-infections, as kidney disease can develop silently and lead to serious complications.
HIV and Hepatitis B: 14.8% of Co-infected Patients Suffer Kidney Failure
Researchers analyzed data from 23,415 individuals with an average age of 37, participating in an Asian cohort study conducted across seven countries and territories between 2010 and 2021. The study compared rates of kidney failure in people living with HIV, with and without co-infection with hepatitis B. Among the participants, 79.3% reported heterosexual transmission of HIV, and 83.6% were receiving antiretroviral therapy. The presence of hepatitis B was determined by detecting the hepatitis B surface antigen, while kidney failure was defined as an estimated glomerular filtration rate (eGFR) of over 60 mL/min/1.73 m².
The results showed that 8% of all participants had kidney failure. However, the rate was substantially higher – 14.8% – among those living with both HIV and hepatitis B, compared to 7.6% in those without the co-infection. Most cases of kidney failure identified were at stage III, indicating moderate to severe impairment.
Kidney Failure: 3 Risk Factors Identified
The study identified several factors linked to kidney dysfunction in individuals with both viruses. Adults aged 50 and older had a more than six-fold increased risk of kidney failure compared to those aged 18-29. Living in an upper-middle-income country and having low platelet counts were also associated with a higher risk. Conversely, a higher CD4 count – a measure of immune system health – was found to significantly reduce the likelihood of kidney failure.
Risk Varies Based on Antiretroviral Therapy Regimen
Researchers also observed differences in risk based on the specific antiretroviral therapy (ART) regimen used. Individuals receiving a combination of nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), or NRTIs and protease inhibitors, had a lower risk of kidney failure compared to those on a regimen of NRTIs and integrase strand transfer inhibitors (INSTIs). The study noted that there was no significant difference observed between tenofovir disoproxil fumarate and tenofovir alafenamide, although the sample size for tenofovir alafenamide was limited.
“These medications are essential for care in the Asia-Pacific region, so understanding their long-term impact on kidney health is crucial, especially in people with co-infection,” said Thinh Toan Vu, who led the study. “This will help ensure safe and effective treatment.” The findings, published in AIDS Research and Therapy, underscore the need for tailored monitoring and management strategies for individuals co-infected with HIV and hepatitis B.
