International Mentored Scientist Award

In Uganda, people living with HIV(PLWH) are growing into old age owing to increased access to antiretroviral therapy. Despite this success, living with HIV has been associated with a substantial burden of non-communicable diseases like diabetes mellitus, hypertension, and they are particularly three times likely to get chronic kidney disease (CKD) than the HIV-negative population. Diagnosis and stratification of CKD rely on glomerular filtration rate (GFR) estimation based on creatinine, a biomarker that is affected by multiple non-GFR determinants like muscle mass, frailty, and physical activity. In contrast, cystatin C has fewer non-GFR determinants and may more objectively estimate GFR in old PLWH. Compared with creatinine, cystatin C may more accurately risk stratify patients at high risk of poor outcomes like mortality, cardiovascular risk, and kidney failure. Additionally, differences between creatinine and cystatin C have been shown to predict these adverse outcomes in research done in well-resourced countries where population characteristics may be different from those of PLWH in Uganda and sub-Saharan Africa. In this study, we aim i) to compare the burden of CKD at baseline between cystatin C- and creatinine-based estimates of glomerular filtration rate (eGFRcys and eGFRcr, respectively) among older PLWH in Uganda and ii) to estimate the differences in longitudinal eGFRcys and eGFRcr over 2 years and determine baseline predictors of diverging eGFRcys and eGFRcr among older PLWH in Uganda. To accomplish these aims, we will capitalize on the prospective HIV geriatric cohort in sub-Saharan Africa (HASA) which comprises 500 PLWH aged 60 years residing in Uganda. Study results will provide an understanding of the utility of cystatin C in assessing CKD and the implications for diverging eGFRcys and eGFRcr on CKD progression among older PLWH. Data may form a foundation for implementing cystatin C measurements in routine screening and diagnosis of CKD in older PLWH.