Chronic kidney disease (CKD) in HIV positive people linked to time with low CD4 count: partly reversible after effective ART

Simon Collins, HIV i-Base

The large prospective D:A:D cohort, with approximately 49,000 participants, looked at a range of markers of HIV-related immunosuppression, including baseline, nadir and recovery CD4 counts and time spent <200 cells/mm3

This analysis included 33,791 participants followed from 2004 to 2016. During a median of 8 years follow-up, 2226 participants (6.6%) developed CKD, defined as eGFR <60  mL/min/1.73. The majority (6.3%) developed grade 3 (eGFR <60 to >30).

However, 0.3% developed grade 4 and 0.3% grade 5, with 0.1% needing chronic dialysis and 0.01% a kidney transplant.

In univariate analysis, all measures of immunosuppression measures predicted CKD.

In mutivariate analysis, including all factors in the D:A:D 5-year CKD calculator, the strongest predictor was the percentage of time spent with a CD4 ≤200 cells/mm3: 0 vs >25%; IRR: 0.77 (95%CI:  0.68 to 0.88).

The highest effect was in people at low D:A:D CKD risk: IRR 0.45 (95% CI: 0.24 to 0.80) vs 0.80 (95% CI: 0.70 to 0.93).

Of the 4328 with baseline CD4 <200 cells/mm3, 309 developed CKD.

The results also suggested that the increased risk from severe immunosuppression may be at least partially reversible after immune recovery to >500 cells/mm3 on ART when CKD was rare.


Although this study was presented in part at CROI 2016, the publication of the full dataset is important to report.


Ryom L et al. The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study.JID  223(4):632–637. DOI:10.1093/infdis/jiaa396. (5 February 2021).

This report was first posted on 1 March 2021.

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