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

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). METHODS: Nationwide study including Swedish residents born 1930-2006, diagnosed with T2DM between 2010 and 2019, followed until 31 December 2024, using 7 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 (adjHRs) 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, 7.8 years; PWoH, 8.8 years). PWH had higher renal risk than PWoH (major adverse kidney event: adjHR, 2.04; 95% CI, 1.57-2.65) but no significantly increased cardiovascular risk (major adverse cardiovascular event: adjHR, 1.18; 95% CI, .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 plasma/serum-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. CONCLUSIONS: 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.