Sickle Cell Trait and Kidney Disease in People of African Ancestry With HIV

study group, GEN-AFRICA; K.Y. Hung, Rachel; Binns-Roemer, Elizabeth; W. Booth, John; Hilton, Rachel; Fox, Julie; Burns, Fiona; Harber, Mark; Ustianowski, Andrew; Hamzah, Lisa; E. Burns, James; Clarke, Amanda; A. Price, David; Kegg, Stephen; Onyango, Denis; Santana-Suarez, Beatriz; Campbell, Lucy; Bramham, Kate; Sharpe, Claire; A. Sabin, Caroline; A. Winkler, Cheryl; Post, Frank; Booth, John; Waters, Anele; Hand, James; Clarke, Chris; Murphy, Sarah; Murphy, Maurice; Campbell, Marion; Richardson, Celia; Knott, Alyson; Weir, Gemma; Cleig, Rebecca; Soviarova, Helena; Barbour, Lisa; Adams, Tanya; Kennard, Vicky; Trevitt, Vittorio; Jones, Rachael; Levy, Jeremy; Schoolmeester, Alexandra; Duro, Serah; Rabuya, May; Jordan, Deborah; Solano, Teresa; Post, Frank; Poulton, Mary; Flaherty, Jan; Patel, Bijal; Manning, Alex

Abstract

Introduction
Sickle cell trait (SCT) has been associated with chronic kidney disease (CKD) in African Americans, although evidence for its impact in Africans and people with HIV is currently lacking. We conducted a cross-sectional study investigating the association between SCT and kidney disease in people of African ancestry with HIV in the UK.

Methods
The primary outcome was estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. Secondary outcomes were eGFR <90 ml/min per 1.73 m2, end-stage kidney disease (ESKD; eGFR <15 ml/min per 1.73 m2, chronic dialysis, or having received a kidney transplant), proteinuria (protein-to-creatinine ratio >50 mg/mmol), and albuminuria (albumin-to-creatinine ratio >3 mg/mmol). Multivariable logistic regression was used to estimate the associations between SCT and kidney disease outcomes.

Results
A total of 2895 participants (mean age 48.1 [SD 10.3], 57.2% female) were included, of whom 335 (11.6%) had SCT and 352 (12.2%) had eGFR <60 ml/min per 1.73 m2. After adjusting for demographic, HIV, and kidney risk factors including APOL1 high-risk genotype status, individuals with SCT were more likely to have eGFR <60 ml/min per 1.73 m2 (odds ratio 1.62 [95% CI 1.14–2.32]), eGFR <90 ml/min per 1.73 m2 (1.50 [1.14–1.97]), and albuminuria (1.50 [1.09–2.05]). Stratified by APOL1 status, significant associations between SCT and GFR <60 ml/min per 1.73 m2, eGFR <90 ml/min per 1.73 m2, proteinuria, and albuminuria were observed for those with APOL1 low-risk genotypes.

Conclusion
Our results extend previously reported associations between SCT and kidney disease to people with HIV. In people of African ancestry with HIV, these associations were largely restricted to those with APOL1 low-risk genotypes.

Citation

study group, G.-A., K.Y. Hung, R., Binns-Roemer, E., W. Booth, J., Hilton, R., Fox, J., Burns, F., Harber, M., Ustianowski, A., Hamzah, L., E. Burns, J., Clarke, A., A. Price, D., Kegg, S., Onyango, D., Santana-Suarez, B., Campbell, L., Bramham, K., Sharpe, C., A. Sabin, C., …Manning, A. (2022). Sickle Cell Trait and Kidney Disease in People of African Ancestry With HIV. Kidney International Reports, 7(3), 465-473. https://doi.org/10.1016/j.ekir.2021.12.007

• Journal Article Type: Article
• Acceptance Date: Dec 6, 2021
• Online Publication Date: Dec 13, 2021
• Publication Date: Mar 1, 2022
• Deposit Date: Jun 2, 2025
• Publicly Available Date: Jun 5, 2025
• Journal: Kidney International Reports
• Print ISSN: 2468-0249
• Electronic ISSN: 2468-0249
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 7
• Issue: 3
• Pages: 465-473
• DOI: https://doi.org/10.1016/j.ekir.2021.12.007
• Keywords: Africa, APOL1, HIV , kidney , SCT, sickle cell trait
• Public URL: https://nottingham-repository.worktribe.com/output/49829694
• Publisher URL: https://www.kireports.org/article/S2468-0249(21)01597-7/fulltext