Drug-Using HIV+ Women at Higher Risk of Kidney Problems Than Men

— More women had impaired renal function, detectable viral load


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NEW ORLEANS -- HIV-positive women in a methadone clinic were more likely than men to have impaired renal function at same time as they had higher viral load, researchers found here.

A higher portion of women versus men had an estimated glomerular filtration rate (eGFR) of <60 mL/min while having detectable HIV RNA (16.9% vs 5.4%, P=0.005), reported Justyna D. Kowalska, MD, of Medical University of Warsaw in Poland, and colleagues.

Moreover, there was a significantly higher percentage of women with an overall decline in renal function compared to men (31% versus 14%, P=0.002).

At a poster presentation at the ASM Microbe meeting, Kowalska told MedPage Today that a large international trial a few years ago showed that HIV-infected women are at higher risk of developing kidney disease, which is the exact opposite of the general population, so her group thought that was something worth exploring.

"We wanted to show a gender difference in the way people handle this methadone treatment program and in their antiretroviral treatment response," she said, adding the fact women have more renal disease in this program and it's "very openly related" to having a detectable viral load.

"Women are more likely to be non-adherent to treatment for different psychological and mental reasons than men, and that affects their kidneys," Kowalska said.

This was a retrospective study that examined data from 276 patients at a methadone program from 1994 to 2015. Overall, 31.1% were women, more than half were registered before 1999 and over 80% were infected with HIV through the use of injectable drugs. Estimated GFR was calculated with the MDRD formula and each eGFR <60 was reviewed by the methadone program physician.

Women were significantly younger than men at the time of enrollment in the HIV clinic (mean age 28 versus 31, P=0.018) and were significantly younger when they started combination antiretroviral therapy (mean age 33 versus 36, respectively, P=0.005).

Moreover, women HIV RNA >50 copies/mL were more than twice as likely to have poor renal function (OR 2.42, 95% CI 0.73-8.04, P=0.148), though the difference was non-significant and with a wide confidence interval. Additional risk factors for women with eGFR <60 mL/min included age of registration at the clinic in years (OR 1.46, 95% CI 1.02-2.08, P=0.037).

There were no significant differences between genders when examining the likelihood to have HIV RNA <50 copies/mL or >50 copies/mL after starting combination antiretroviral therapy. There was also no significant difference between genders in abstaining from psychoactive substances.

Kowalska said that she hoped her group's results would have an impact on standards of care for HIV-positive women and that mainly translates to physician awareness about the differences in the sexes. She cited anecdotal evidence that HIV-positive women are more likely to be adherent to antiviral treatment when they are pregnant, but once they deliver, a large portion of women stop treatment.

"The message is that clinicians need to be aware and handle women maybe differently than men in such programs, because psychological issues can translate directly into physical diseases," Kowalska said.