BACKGROUND: Hepatitis C virus (HCV) infection has been associated with increased risk of chronic kidney disease (CKD). We investigated the impact of HCV cure on CKD in HIV-positive persons in the EuroSIDA study. METHODS: HIV-positive persons with known HCV status and at least three serum creatinine measurements after 1/1/2004 were compared based on time-updated HCV-RNA and HCV treatment: anti-HCV-negative, spontaneously cleared HCV, chronic untreated HCV, successfully treated HCV, and HCV-RNA positive after HCV treatment. Poisson regression compared incidence rates of CKD [confirmed (>3 months apart) eGFR <60 ml/min per 1.73 m] between HCV strata. RESULTS: Fourteen thousand, seven hundred and fifty-four persons were included; at baseline 9273 (62.9%) were HCV-Ab negative, 696 (4.7%) spontaneous clearers, 3021 (20.5%) chronically infected, 922 (6.2%) successfully treated and 842 (5.7%) HCV-RNA positive after treatment. During 115 335 person-years of follow-up (PYFU), 1128 (7.6%) developed CKD; crude incidence 9.8/1000 PYFU (95% CI 9.2-10.4). After adjustment, persons anti-HCV negative [adjusted incidence rate ratio (aIRR) 0.59; 95% CI 0.46-0.75] and spontaneous clearers (aIRR 0.67; 95% CI 0.47-0.97) had significantly lower rates of CKD compared with those cured whereas persons chronically infected (aIRR 0.85; 95% CI 0.65-1.12) and HCV-RNA positive after treatment (aIRR 0.71; 95% CI 0.49-1.04) had similar rates. Analysis in those without F3/F4 liver fibrosis using a more rigorous definition of CKD showed similar results. CONCLUSION: This large study found no evidence that successful HCV treatment reduced CKD incidence. Confounding by indication, where those with highest risk of CKD were prioritized for HCV treatment in the DAA era, may contribute to these findings.

Centre for Clinical Research Epidemiology Modelling and Evaluation London United Kingdom

Centre Hospitalier de Luxembourg Service des Maladies Infectieuses Luxemburg

Charles University Hospital Plzen Plzen Czech Republic

Department of Clinical Microbiology and Infectious Diseases Hadassah Hospital Jerusalem Israel

Department of Infectious Diseases Bern University Hospital Bern Switzerland

Department of Infectious Diseases Ljubljana University Medical Center Ljubljana Slovenia

Department of Infectious Diseases Rigshospitalet University of Copenhagen Centre of Excellence for Health Immunity and Infections Copenhagen Denmark

Department of Medicine 1 University Hospital Bonn Bonn Germany

Helsinki University Hospital Division of Infectious Diseases Helsinki Finland

Hospital Clinic Infectious Diseases Service Barcelona Spain

Infectious Diseases AIDS and Clinical Immunology Research Center Tbilisi Georgia

Institute of Tropical Medicine Antwerp Belgium

Ippokration General Hospital Athens Greece

Nordsjællands Hospital Hillerød Denmark

Sorbonne Université IPLESP Inserm UMR S AP HP France

South Pest Hospital Centre National Institute for Infectology and Haematology Hungary Budapest

University Hospital Germans Trias i Pujol Badalona Barcelona Spain

University of Belgrade School of Medicine Belgrade Serbia

Victor Babes Clinical Hospital for Infectious and Tropical Diseases Bucharest Romania

Vilnius University Hospital Santariskiu Klinikos Vilnius Lithuania

Western General Hospital Edinburgh United Kingdom

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