title: The association between APOL1 risk alleles and longitudinal kidney function differs by HIV viral suppression status.
abstract: BACKGROUND
  Existing data suggest that human immunodeficiency virus (HIV)-infected African Americans carrying 2 copies of the APOL1 risk alleles have greater risk of kidney disease than noncarriers. We sought to determine whether HIV RNA suppression mitigates APOL1-related kidney function decline among African Americans enrolled in the Multicenter AIDS Cohort Study.
  
  
  METHODS
  We genotyped HIV-infected men for the G1 and G2 risk alleles and ancestry informative markers. Mixed-effects models were used to estimate the annual rate of estimated glomerular filtration rate (eGFR) decline, comparing men carrying 2 (high-risk) vs 0-1 risk allele (low-risk). Effect modification by HIV suppression status (defined as HIV type 1 RNA level <400 copies/mL for >90% of follow-up time) was evaluated using interaction terms and stratified analyses.
  
  
  RESULTS
  Of the 333 African American men included in this study, 54 (16%) carried the APOL1 high-risk genotype. Among HIV-infected men with unsuppressed viral loads, those with the high-risk genotype had a 2.42 mL/minute/1.73 m(2) (95% confidence interval [CI], -3.52 to -1.32) faster annual eGFR decline than men with the low-risk genotype. This association was independent of age, comorbid conditions, baseline eGFR, ancestry, and HIV-related factors. In contrast, the rate of decline was similar by APOL1 genotype among men with sustained viral suppression (-0.16 mL/minute/1.73 m(2)/year; 95% CI, -.59 to .27; P for interaction <.001).
  
  
  CONCLUSIONS
  Unsuppressed HIV-infected African Americans with the APOL1 high-risk genotype experience an accelerated rate of kidney function decline; HIV suppression with antiretroviral therapy may reduce these deleterious renal effects.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
authors.forename: Man
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Tin
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.affiliation: Department of Medicine Department of Epidemiology and Biostatistics, University of California Department of General Internal Medicine, San Francisco Veterans Affairs Medical Center, California.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Penugonda
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles.
authors.forename: Shehnaz K
authors.initials: SK
authors.lastname: Hussain
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Wolinsky
authors.affiliation: Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Martinson
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada.
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
authors.forename: W H Linda
authors.initials: WH
authors.lastname: Kao
mesh_terms: D001741:Black or African American / Q000235:genetics*; D000483:Alleles; D023241:Antiretroviral Therapy, Highly Active; D000075944:Apolipoprotein L1; D001053:Apolipoproteins / Q000235:genetics*; D015331:Cohort Studies; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D005838:Genotype; D005919:Glomerular Filtration Rate / Q000235:genetics; D006678:HIV / Q000235:genetics / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology* / Q000821:virology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008075:Lipoproteins, HDL / Q000235:genetics*; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D019562:Viral Load
chemical_list: C108666:APOL1 protein, human; D000075944:Apolipoprotein L1; D001053:Apolipoproteins; D008075:Lipoproteins, HDL; D012367:RNA, Viral
keywords: HIV; antiretroviral therapy; genetic; kidney disease