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. 2022 Dec 1;12(12):e064970.
doi: 10.1136/bmjopen-2022-064970.

Increased kidney disease mortality among people with AIDS versus the general population: a population-based cohort study in Italy, 2006-2018

Martina Taborelli  1 , Barbara Suligoi  2 , Diego Serraino  3 , Luisa Frova  4 , Enrico Grande  4 , Federica Toffolutti  3 , Vincenza Regine  2 , Marilena Pappagallo  4 , Lucia Pugliese  2 , Francesco Grippo  4 , Antonella Zucchetto  3
Affiliations

Increased kidney disease mortality among people with AIDS versus the general population: a population-based cohort study in Italy, 2006-2018

Martina Taborelli et al. BMJ Open. .

Abstract

Objectives: This study aimed to assess whether an excess mortality related to kidney and other urinary tract diseases exists among Italian people with AIDS (PWA), as compared with the general population without AIDS (non-PWA).

Design: Population-based, retrospective cohort study.

Setting and participants: We conducted a nationwide study including 9481 Italian PWA, aged 15-74 years, reported to the National AIDS Registry between 2006 and 2018.

Methods: Vital status and causes of death were retrieved by record linkage with the National Register of Causes of Death up to 2018. Excess mortality for PWA versus non-PWA was estimated through sex-standardised and age-standardised mortality ratios (SMRs) with corresponding 95% CIs.

Results: Among 2613 deceased PWA, 262 (10.0%) reported at least one urinary tract disease at death, including 254 (9.7%) non-cancer diseases-mostly renal failures (225 cases, 8.6%)-and 9 cancers (0.3%). The overall SMR for non-cancer urinary tract diseases was 15.3 (95% CI 13.4 to 17.3) with statistically significant SMRs for acute (SMR=22.3, 95% CI 18.0 to 27.4), chronic (SMR=8.4, 95% CI 6.0 to 11.3), and unspecified renal failure (SMR=13.8, 95% CI 11.2 to 16.8). No statistically significant excess mortality was detected for urinary tract cancers (SMR=1.7, 95% CI 0.8 to 3.3). The SMRs were particularly elevated among PWA aged <50 years, injecting drug users, or those with the first HIV-positive test >6 months before AIDS diagnosis.

Conclusions: The excess mortality related to non-cancer kidney and other urinary tract diseases reported among PWA highlights the importance of implementing the recommendation for screening, diagnosis and management of such conditions among this population.

Keywords: EPIDEMIOLOGY; HIV & AIDS; Kidney tumours.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of the (A) PWA and (B) non-PWA deaths. PWA, people with AIDS.
Figure 2
Figure 2
Standardised mortality ratios (SMR) and corresponding 95% CIs according to selected causes of death reported in death certificates of people with AIDS (PWA), as compared with people without HIV/AIDS, by age at death (A), mode of HIV transmission (B), and timing of first HIV+testing (C). Italy, 15­–74-year PWA, 2006­–2018. a‘Early testers’: PWA whose AIDS diagnosis was made >6 months from first HIV+testing. ‘Late testers’: PWA whose AIDS diagnosis was made ≤6 months from first HIV+testing. bNo observed cases among PWA.
See this image and copyright information in PMC

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