HIV-infected persons are at greater risk of accelerated aging complications, including premature kidney, heart, and bone diseases. In the presence of HIV infection, the effect of aging on the kidney appears to be accelerated by 1-2 decades. HIV-infected persons have a 10-fold prevalence of impaired kidney function and risk of end-stage renal disease (ESRD) compared with matched controls. In addition, kidney disease adversely affects bone health and is associated with fracture risk. These effects may be compounded by the nephrotoxic effects of tenofovir, a first-line treatment of HIV infection, which has been associated with decreased bone mineral density;tenofovir's bone toxicity is likely due to kidney tubular injury and resulting impairments in bone mineral homeostasis. It is widely agreed that the key strategy to prevent the complications of kidney disease is early diagnosis and provision of care. However, a major challenge in clinical practice is the current reliance on serum creatinine and albuminuria testing to detect kidney injury and disease. Kidney function estimates based on creatinine are unreliable until the glomerular filtration rate (GFR) has been substantially reduced;by this time, kidney disease is established and the primary prevention window has closed. Albuminuria captures only a small fraction of the kidney injury in HIV-infected persons and is therefore insufficient as a screening tool for kidney disease. This proposal envisions a new paradigm for early diagnosis of kidney disease in persons with HIV-infection. The strategy will be to use targeted serum and urine biomarkers to detect kidney injury at its earliest stages at multiple sites within the kidney, and to determine whether early kidney injury adversely effects bone mineral metabolism in ways that lead to accelerated osteoporosis. To address these key issues related to kidney disease in the aging HIV-infected population, we will add novel biomarkers of injury to the microvasculature, tubules, and interstitium of the kidney and of bone mineral metabolism to the ongoing Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS). Our first objective will be to compare kidney injury markers among HIV-infected and uninfected participants cross-sectionally, and their association with age, tenofovir use, and GFR. The second objective will be to examine the link between HIV-infection, advancing age, declining GFR, and tenofovir use with the disorders of mineral metabolism and reduced bone mineral density. The third objective will be to evaluate longitudinally whether baseline and follow-up markers of kidney injury are independently associated with accelerated declines in kidney function during follow-up.

Public Health Relevance

Age-related declines in kidney function appear to be accelerated by nearly two decades in HIV-infected persons, and the resulting kidney disease predisposes to higher risk of death and bone disease. Current strategies for detecting kidney disease are narrowly focused, providing a diagnosis in only a small fraction of affected individuals or diagnosing the disease late in its course. This proposal envisions a new paradigm for early detection of kidney injury in persons with HIV-infection through the use of novel, site-specific serum and urine biomarkers to detect injury at multiple locations within the kidney at their earliest, preclinical stage.

National Institute of Health (NIH)
National Institute on Aging (NIA)
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AIDS Clinical Studies and Epidemiology Study Section (ACE)
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Zieman, Susan
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Northern California Institute Research & Education
San Francisco
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Jotwani, Vasantha; Scherzer, Rebecca; Estrella, Michelle M et al. (2016) HIV Infection, Tenofovir, and Urine α1-Microglobulin: A Cross-sectional Analysis in the Multicenter AIDS Cohort Study. Am J Kidney Dis 68:571-81
Baxi, Sanjiv M; Scherzer, Rebecca; Jotwani, Vasantha et al. (2016) Changes in Urinary Biomarkers over 10 Years is Associated with Viral Suppression in a Prospective Cohort of Women Living with HIV. J Acquir Immune Defic Syndr :
Kim, Julie E; Scherzer, Rebecca; Estrella, Michelle M et al. (2016) Tenofovir exposure alters associations of serum bicarbonate with chronic kidney disease risk in HIV-infected veterans. AIDS 30:1049-57
Scherzer, Rebecca; Lin, Haiqun; Abraham, Alison et al. (2016) Use of urine biomarker-derived clusters to predict the risk of chronic kidney disease and all-cause mortality in HIV-infected women. Nephrol Dial Transplant 31:1478-85
Baxi, Sanjiv M; Scherzer, Rebecca; Greenblatt, Ruth M et al. (2016) Higher tenofovir exposure is associated with longitudinal declines in kidney function in women living with HIV. AIDS 30:609-18
Jotwani, Vasantha; Scherzer, Rebecca; Estrella, Michelle M et al. (2016) Brief Report: Cumulative Tenofovir Disoproxil Fumarate Exposure is Associated With Biomarkers of Tubular Injury and Fibrosis in HIV-Infected Men. J Acquir Immune Defic Syndr 73:177-81
Ascher, Simon B; Scherzer, Rebecca; Peralta, Carmen A et al. (2016) Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women. Hypertension :
Jotwani, Vasantha; Scherzer, Rebecca; Abraham, Alison et al. (2015) Association of urine α1-microglobulin with kidney function decline and mortality in HIV-infected women. Clin J Am Soc Nephrol 10:63-73
Jotwani, Vasantha; Shlipak, Michael G; Scherzer, Rebecca et al. (2015) APOL1 Genotype and Glomerular and Tubular Kidney Injury in Women With HIV. Am J Kidney Dis 65:889-98
Jotwani, Vasantha; Scherzer, Rebecca; Abraham, Alison et al. (2014) Does HIV infection promote early kidney injury in women? Antivir Ther 19:79-87

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