The association of mild kidney disease with coronary artery disease is stronger for people living with HIV.

Objective: To examine the association between mild kidney disease and coronary plaque parameters using coronary computed tomography angiography (CCTA) in people living with HIV (PWH) compared to people without HIV in Uganda. Design: Cross-sectional secondary analysis. Methods: We studied 165 participants aged >45 years with ≥1 cardiovascular risk factor (78 PWH on stable antiretroviral therapy, 87 HIV-negative). Kidney function was assessed using estimated glomerular filtration rate (eGFR) and albumin–creatinine ratio (ACR). Coronary artery disease (CAD) was characterized by segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium (CAC) score. Multivariable Tobit regression assessed associations of kidney function measures with CAD parameters, testing for differences by HIV status. Results: The median (interquartile range, IQR) age was 57.0 (53, 62) years, 62.4% of subjects were female, and 87.3% had hypertension. Among PWH, mildly impaired eGFR (<90mL/min/1.73 m 2 ) was associated with higher SIS (β 3.31, 95% CI: 0.41 to 6.21, p = 0.03) and SSS (β 5.95, 95% CI: 0.54 to 11.36, p = 0.03). The association with SIS remained significant after adjusting for age, gender, and 10-year ASCVD score (β 2.58, 95% CI: 0.10 to 5.06, p = 0.04). Associations of ACR with coronary plaque were not statistically significant for participants with or without HIV (all p>0.07). Conclusion: In PWH, mildly reduced eGFR was associated with greater coronary plaque burden (SIS, SSS) but not CAC; ACR showed no associations with any CAD measures. Incorporating kidney function measures into cardiovascular risk assessment may be valuable in HIV care.