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Renal and Cardiovascular Complications Following Type 2 Diabetes Mellitus in People With and Without HIV : Data from Cohort Study on Morbidity and HIV in Sweden (COSMOHS) between 2010-2024

Killander Möller, Isabela ; Wagner, Philippe LU ; Brännström, Johanna ; Bäckdahl, Tintin ; Elvstam, Olof LU orcid ; Gisslén, Magnus ; Hedberg, Pontus ; Mellgren, Åsa ; Månsson, Fredrik LU and Nauclér, Pontus LU , et al. (2026) In Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Abstract

BACKGROUND: Type 2 diabetes mellitus (T2DM) is common among people with HIV (PWH), although studies comparing T2DM-related complications in people with and without HIV (PWoH) remain limited. This was assessed using data from the Cohort Study on Morbidity and HIV in Sweden (COSMOHS).

METHOD: Nationwide study including Swedish residents born 1930-2006, diagnosed with T2DM between 2010 and 2019, followed until 2024-12-31, utilizing seven national registers including national HIV and diabetes registers. Follow-up began at T2DM diagnosis. Outcomes included renal events, cardiovascular events, and all-cause mortality. Cox proportional regression estimated hazard ratios (adjHR) by HIV status, stratified by propensity score quintiles of... (More)

BACKGROUND: Type 2 diabetes mellitus (T2DM) is common among people with HIV (PWH), although studies comparing T2DM-related complications in people with and without HIV (PWoH) remain limited. This was assessed using data from the Cohort Study on Morbidity and HIV in Sweden (COSMOHS).

METHOD: Nationwide study including Swedish residents born 1930-2006, diagnosed with T2DM between 2010 and 2019, followed until 2024-12-31, utilizing seven national registers including national HIV and diabetes registers. Follow-up began at T2DM diagnosis. Outcomes included renal events, cardiovascular events, and all-cause mortality. Cox proportional regression estimated hazard ratios (adjHR) by HIV status, stratified by propensity score quintiles of age, sex, migrant status, comorbidities, and socioeconomics.

RESULTS: 350 PWH and 311 668 PWoH were included, with similar median follow-up time (PWH: 7.8y, PWoH: 8.8y). PWH had higher renal risk compared to PWoH (major adverse kidney event: adjHR 2.04 95% CI 1.57-2.65) but no significantly increased risk of cardiovascular events (major adverse cardiovascular event: adjHR 1.18, 95% CI 0.87-1.60) or all-cause mortality. Findings were consistent across sensitivity analyses, including competing-risk models for death and excluding PWH receiving tenofovir disoproxil fumarate at baseline. Accounting for the benign P/S-creatinine increase associated with bictegravir, cobicistat, dolutegravir, and rilpivirine, the increased renal risk remained although not statistically significant. The renal risk was most prominent in PWH with BMI ≥30 kg/m2.

CONCLUSION: In this nationwide cohort, PWH with T2DM exhibited higher risk of renal complications than PWoH, indicating enhanced renal monitoring may be warranted. Further research should investigate underlying mechanisms, including antiretroviral therapy, to guide clinical management.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
HIV, Diabetes Mellitus, diabetes complications, Epidemiology, type 2, kidney, morbidity, cardiac complications, hiv patients
in
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
article number
ciag261
pages
22 pages
publisher
Oxford University Press
external identifiers
  • pmid:41999291
ISSN
1537-6591
DOI
10.1093/cid/ciag261
language
English
LU publication?
yes
additional info
© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
id
1911d8d3-9316-44ab-91a0-bb742b9de8a1
date added to LUP
2026-04-20 08:07:50
date last changed
2026-04-20 08:35:02
@article{1911d8d3-9316-44ab-91a0-bb742b9de8a1,
  abstract     = {{<p>BACKGROUND: Type 2 diabetes mellitus (T2DM) is common among people with HIV (PWH), although studies comparing T2DM-related complications in people with and without HIV (PWoH) remain limited. This was assessed using data from the Cohort Study on Morbidity and HIV in Sweden (COSMOHS).</p><p>METHOD: Nationwide study including Swedish residents born 1930-2006, diagnosed with T2DM between 2010 and 2019, followed until 2024-12-31, utilizing seven national registers including national HIV and diabetes registers. Follow-up began at T2DM diagnosis. Outcomes included renal events, cardiovascular events, and all-cause mortality. Cox proportional regression estimated hazard ratios (adjHR) by HIV status, stratified by propensity score quintiles of age, sex, migrant status, comorbidities, and socioeconomics.</p><p>RESULTS: 350 PWH and 311 668 PWoH were included, with similar median follow-up time (PWH: 7.8y, PWoH: 8.8y). PWH had higher renal risk compared to PWoH (major adverse kidney event: adjHR 2.04 95% CI 1.57-2.65) but no significantly increased risk of cardiovascular events (major adverse cardiovascular event: adjHR 1.18, 95% CI 0.87-1.60) or all-cause mortality. Findings were consistent across sensitivity analyses, including competing-risk models for death and excluding PWH receiving tenofovir disoproxil fumarate at baseline. Accounting for the benign P/S-creatinine increase associated with bictegravir, cobicistat, dolutegravir, and rilpivirine, the increased renal risk remained although not statistically significant. The renal risk was most prominent in PWH with BMI ≥30 kg/m2.</p><p>CONCLUSION: In this nationwide cohort, PWH with T2DM exhibited higher risk of renal complications than PWoH, indicating enhanced renal monitoring may be warranted. Further research should investigate underlying mechanisms, including antiretroviral therapy, to guide clinical management.</p>}},
  author       = {{Killander Möller, Isabela and Wagner, Philippe and Brännström, Johanna and Bäckdahl, Tintin and Elvstam, Olof and Gisslén, Magnus and Hedberg, Pontus and Mellgren, Åsa and Månsson, Fredrik and Nauclér, Pontus and Nilsson, Josefin and Nowak, Piotr and Sparén, Pär and Eliasson, Björn and Carlander, Christina}},
  issn         = {{1537-6591}},
  keywords     = {{HIV; Diabetes Mellitus; diabetes complications; Epidemiology; type 2; kidney; morbidity; cardiac complications; hiv patients}},
  language     = {{eng}},
  month        = {{04}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical infectious diseases : an official publication of the Infectious Diseases Society of America}},
  title        = {{Renal and Cardiovascular Complications Following Type 2 Diabetes Mellitus in People With and Without HIV : Data from Cohort Study on Morbidity and HIV in Sweden (COSMOHS) between 2010-2024}},
  url          = {{http://dx.doi.org/10.1093/cid/ciag261}},
  doi          = {{10.1093/cid/ciag261}},
  year         = {{2026}},
}