Jointly conducted by IRD and INSERM, this research analyzes renal function in people living with HIV in sub-Saharan Africa.
Nongodo Firmin Kabore, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2019 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
Sub-Saharan Africa is facing a major public health challenge, with nearly 500 million people suffering from chronic kidney diseases (CKD). This alarming situation is even more concerning for people living with HIV (PLHIV), who represent a particularly vulnerable population. Indeed, kidney diseases can worsen the progression of HIV and vice versa, creating a vicious cycle that complicates the management of these patients. The implications of this dual vulnerability are considerable, both medically and socio-economically.
The vulnerability of PLHIV is exacerbated by genetic factors, notably variants of the APOL1 gene, which are more common in this region. This gene plays a crucial role in protection against certain infections, but specific variants can also increase the risk of developing CKD. However, the results of the study conducted by Nongodo Firmin Kabore reveal a nuanced situation. The prevalence and incidence of CKD among PLHIV in West Africa are low to moderate, unlike other studies conducted in different regions of the world, where the incidence of kidney diseases among PLHIV is often alarming. This raises questions about the understanding of renal risks in this population, and it becomes imperative to explore the reasons for this disparity.
It is essential to examine the reasons for this disparity. Risky genetic variants of the APOL1 gene are present in only 3 to 5% of PLHIV, which is lower than expected. This observation could indicate that other factors, such as age, immunosuppression, hypertension, and exposure to certain antiretroviral treatments, play a more significant role in renal health. For example, hypertension, which is a major public health issue in Africa, could contribute to increased risks of CKD, regardless of HIV status.
The study also validated a predictive score for CKD, initially designed for Western PLHIV, demonstrating its utility in sub-Saharan Africa. This paves the way for screening and prevention strategies tailored to local specifics. Indeed, adapting this score could allow for early identification of at-risk patients, thus facilitating rapid and targeted intervention. Public health programs could integrate this score into their screening protocols, contributing to better management of kidney diseases in this population.
Policymakers must take these results into account to develop targeted public health policies. Implementing early screening and prevention programs for renal complications could significantly improve the quality of life for PLHIV. For example, awareness campaigns on the importance of monitoring renal health, coupled with regular consultations, could help reduce the incidence of CKD. Furthermore, it is crucial to invest in research to better understand the interactions between genetics and environment in the African context.
It is also important to consider the socio-economic implications of this research. Kidney diseases can lead to high costs for health systems, particularly due to the treatments required to manage complications. By improving prevention and screening, countries in sub-Saharan Africa could not only enhance the health of their populations but also reduce long-term healthcare expenditures.
In summary, this research highlights the complexity of kidney diseases among PLHIV in sub-Saharan Africa. It calls for a thorough reflection on public health approaches and the necessity to adapt screening and prevention strategies to local realities. It is imperative that public health actors, researchers, and policymakers collaborate to develop innovative and tailored solutions to address this public health challenge affecting millions of people in this region of the world.
Key Facts
- 500 million : Total number of people worldwide suffering from chronic kidney diseases.
- 80% : Proportion of these people living in low or middle-income countries.
- 3-5% : Frequency of risk variants of the APOL1 gene among PLHIV in West Africa.
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Sources and Access
Nongodo Firmin Kabore. Analyse épidémio-génétique de la fonction rénale chez les personnes d’Afrique sub-Saharienne vivant avec le VIH. Médecine humaine et pathologie. Université Montpellier, 2019. Français. ⟨NNT : 2019MONTT070⟩. ⟨tel-02650016⟩