Interaction of sex and HIV infection on renal impairment: baseline evidence from the CHART cohort.

• The prevalence of renal impairment (RI) in people living with HIV (PLWH) was comparable with that in HIV-negative individuals overall • The prevalence of RI was higher in HIV-positive females than in HIV-negative females. • Sex-specific correlates of RI were observed in all participants. • HIV infection and sex may act synergistically on RI through fat metabolism. Females are more vulnerable to renal impairment (RI) in people living with HIV (PLWH), but few studies have examined sex disparity in the association of HIV serostatus with RI. In total, 2,101 PLWH on antiretroviral treatment (ART) and 4,202 HIV-negative people were selected and frequency matched in 1:2 ratio by sex and age categories. RI was defined as estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2. The interaction effect of sex with HIV serostatus and correlates of RI were assessed by logistic regression models. In total, 78.2% of participants were males with median age 43.7 (IQR: 32.5-54.4) years. The prevalence of RI was comparable for PLWH and HIV-negative people overall (30.4% vs 30.1%) but significantly higher for HIV-positive females (37.1%) than HIV-negative females (30.1%). Multiple logistic regression identified an interaction between sex and HIV serostatus on RI (adjusted odds ratio [aOR] of the interaction term: 1.66, 95% CI: 1.23-2.26). HIV infection was significantly associated with RI in females (aOR: 1.55, 95% CI: 1.17-2.06) but not in males. Central obesity and nadir CD4 count were significantly associated with RI in HIV-infected females but not in HIV-infected males. Sex seems to modify the association between HIV infection and RI, suggesting a sex-specific mechanistic pathogenesis of RI in PLWH, which warrants further investigation and intervention. [ABSTRACT FROM AUTHOR]