The following is a summary of “Incident Proteinuria differs by HIV Serostatus among Men with Pre-diabetes: The Multicenter AIDS Cohort Study,” published in the February 2024 issue of Infectious Diseases by Slama et al.

Researchers conducted a retrospective study to investigate whether incident proteinuria varies by HIV serostatus among pre-diabetic individuals, considering the higher risk of proteinuria in people living with HIV (PWH) compared to those people without HIV (PWOH).

They assessed urine protein-to-creatinine ratio (PCR) semi-annually in men enrolled in the Multicenter AIDS Cohort Study from April 2006 onwards. Inclusion criteria included men diagnosed with pre-diabetes without prevalent proteinuria or usage of anti-diabetic medications. Pre-diabetes was defined as fasting glucose (FG) levels ranging from 100 to 125 mg/dL, confirmed within a year by repeat FG or hemoglobin A1c levels between 5.7% and 6.4%. Incident proteinuria was determined as PCR exceeding 200 mg/g, confirmed within a year. Poisson regression models were employed to analyze whether incident proteinuria among participants with pre-diabetes varied based on HIV serostatus and, among PWH, whether HIV-specific factors correlated with incident proteinuria.

The results indicated that among 1,276 men (between 2006 and 2019) diagnosed with pre-diabetes, 128 out of 613 PWH (21%) and 50 out of 663 PWOH (8%) developed proteinuria over a median 10-year follow-up. Following multivariable adjustment, the incidence of proteinuria in PWH with pre-diabetes was 3.3 times [95% CI: 2.3–4.8 times] higher than in PWOH (P<0.01). Among PWH, having a current CD4 count <500 cells/mm³ (P<0.01) and the current use of protease inhibitors (P=0.03) were associated with incident proteinuria, while the use of lamivudine and integrase inhibitors was linked to a reduced risk.

Investigators concluded that pre-diabetic men living with HIV have triple the risk of developing proteinuria, highlighting the need for targeted kidney health interventions in this group.

Source: academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciae065/7604459