Host APOL1 genotype is independently associated with proteinuria in HIV infection

• Proteinuria is associated with adverse clinical outcomes in HIV infection. Here we evaluated whether APOL1 risk alleles, previously associated with advanced kidney disease, are independently associated with proteinuria in HIV infection in a cross-sectional study of HIV-infected women in the Women's Interagency HIV Study. We estimated the percent difference in urine protein excretion and odds of proteinuria (≥200 mg/g) associated with two versus one or no APOL1 risk allele using linear and logistic regression, respectively. Of 1285 women successfully genotyped, 379 carried one and 80 carried two risk alleles. Proteinuria was present in 124 women, 78 of whom had proteinuria confirmed on a second sample. In women without prior AIDS, two risk alleles were independently associated with a 69% higher urine protein excretion (95% confidence interval (CI): 36, 108) and five-fold higher odds of proteinuria (95% CI: 2.45, 10.37) as compared with one or no risk allele. No association was found in women with prior AIDS. Analyses in which women with impaired kidney function were excluded and proteinuria was confirmed by a second urine sample yielded similar estimates. Thus, APOL1 risk alleles are associated with significant proteinuria in HIV-infected persons without prior clinical AIDS, independent of clinical factors traditionally associated with proteinuria. Trials are needed to determine whether APOL1 genotyping identifies individuals who could benefit from earlier intervention to prevent overt renal disease. © 2013 International Society of Nephrology.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Infektionsmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Infectious Medicine (hsv//eng)

Keyword

genetic renal disease

HIV

kidney disease

proteinuria

antiretrovirus agent

acquired immune deficiency syndrome

adult

African American

age distribution

allele

APOL1 gene

article

controlled study

cross-sectional study

ethnic difference

female

gene

genetic association

genetic risk

genetic variability

genotype

glomerulus filtration rate

heterozygote

highly active antiretroviral therapy

host

human

Human immunodeficiency virus 1

Human immunodeficiency virus infection

hypertension

kidney dysfunction

major clinical study

medical history

Negro

priority journal

protein urine level

risk assessment

single nucleotide polymorphism

virus load

Publication and Content Type

ref (subject category)

art (subject category)