Coagulation is associated with renal function decline and chronic kidney disease in people living with HIV in South Africa.

Background: Chronic inflammation is a well-documented feature of human immunodeficiency virus (HIV) infection and is implicated in the progression of several comorbidities, including chronic kidney disease (CKD). Notably, chronic coagulation activation is another common phenomenon mediated by chronic inflammation among people living with HIV (PLWH) and has also been linked to CKD progression. However, the relationship between inflammation, coagulation and renal dysfunction remains underexplored in African populations with high HIV prevalence. This study investigated the association between systemic inflammation, coagulation activation and renal function among PLWH, particularly those receiving antiretroviral therapy (ART). Methods: In this cross-sectional study, 151 adults were enrolled, comprising 80 PLWH on ART, 27 PLWH not on ART, and 44 people not living with HIV (PNLWH). Inflammatory marker, C-reactive protein (CRP) and coagulation markers including fibrinogen and D-dimer, were measured and CKD stages were determined using estimated glomerular filtration rate (eGFR), which was calculated based on cystatin C (cystC) levels (eGFR Results: In the overall PLWH cohort, D-dimer was significantly associated with reduced eGFR Conclusion: The study reveals that both D-dimer and fibrinogen, key markers of coagulation are independently associated with renal function decline and risk of CKD in PLWH, particularly those on ART. These findings suggest that coagulation activation may be an early indicator of declining kidney function and increased risk of CKD in PLWH, potentially preceding overt systemic inflammation.