Predictors of long-term progression to chronic kidney disease in HIV infection in Ghana from 2003-2018

Aim HIV is associated with an increased risk of progression to chronic kidney disease (CKD), and this risk is higher in people of West African descent than many other ethnicities. Our study aimed to assess the rates of progression to CKD and predictors of rapid progression in patients receiving antiretroviral therapy (ART) in central Ghana between 2003 and 2018. Methods This single-centre retrospective study enrolled people with HIV (PWH) initiating ART in Ghana between 2003-2018. Demographics, hepatitis B (HBsAg) status, ART regimens and eGFR measurements were recorded, and multi-level model linear regression was performed to determine predictors of greater levels of eGFR decline. Results 659 participants were included in the study with a median follow-up time of 6 years (IQR 3.6-8.9). 149 participants (22.6%) also had confirmed HBV co-infection. Tenofovir was associated with the highest mean rate of eGFR decline of all Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), representing a statistically significant annual decline -1.08 mL/min/1.73m 2 /year (CI: -0.24, -1.92) faster than those taking zidovudine. Regarding other ARTs, both nevirapine (-0.78mL /min/173m 2 /year; CI: -0.17, -1.39) and protease inhibitors (-1.55mL/mil/173m 2 /year; CI: - 0.41, -2.68) were associated with slower eGFR declines compared with efavirenz. Negative HbsAg status was associated with greater eGFR decline compared with positive HBsAg status (-1.25mL/mil/173m 2 ; CI 0.29. 2.20). Conclusion Increased rates of eGFR decline amongst PWH in Ghana were associated with tenofovir, nevirapine, and protease inhibitor use as well as negative HBsAg status. Further higher-quality research is needed to explore long-term predictors of eGFR decline in African populations.