HIV-1 infection of the kidney: mechanisms and implications

Proteinuria and albuminuria among a global primary cardiovascular disease prevention cohort of people with HIV

OBJECTIVES

To determine baseline prevalence of proteinuria and albuminuria among participants from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) and evaluate associated risk factors.

DESIGN

Cross sectional analysis of a baseline sample of participants from the REPRIEVE Trial.

METHODS

REPRIEVE is an international primary cardiovascular prevention randomized controlled trial (RCT) of pitavastatin calcium vs. placebo among people with HIV (PWH) on antiretroviral therapy (ART). A representative subset (2791 participants) had urine collected at study entry. Urine protein to creatinine ratios (uPCR) and albumin to creatinine ratios (uACR) were classified as normal, moderately increased and severely increased. These were dichotomized to Normal or Abnormal for log-binomial regression analysis. Demographic, cardiometabolic, and HIV-specific data were compared among those with normal versus abnormal results.

RESULTS

Overall, median age 49 years, 41% female sex, 47% black or African American race, 36% had estimated glomerular filtration rate (eGFR) less than 90 ml/min/1.73 mm 2 . For uPCR, 27% had moderately or severely increased values. For uACR, 9% had moderately or severely increased values. In the fully adjusted model for proteinuria, female sex, older age, residence in sub-Saharan Africa or East Asia, lower BMI, lower CD4 + cell count, and use of tenofovir disoproxil fumarate (TDF) were associated with abnormal values. In the fully adjusted model for albuminuria, a diagnosis of hypertension (HTN) was associated with abnormal values.

CONCLUSION

Abnormal proteinuria and albuminuria remain common (27 and 9%) despite controlled HIV. Lower current CD4 + count and TDF use were strongly associated with proteinuria. Certain modifiable comorbidities, including HTN and smoking, were associated with abnormal values. In PWH with preserved eGFR, urine measures identify subclinical kidney disease and afford the opportunity for intervention.

Ambient particulate matter and renal function decline in people with HIV/AIDS

OBJECTIVE

We aimed to explore the effect of particulate matter exposure on renal function in people with HIV/AIDS (PWHA).

METHODS

A total of 37 739 repeated measurements were conducted on eGFR levels, serum creatinine (Scr), and the triglyceride-glucose (TyG) index in 6958 PWHAs. The relationship between 1 and 28 day moving averages of particulate matter concentrations with Scr and eGFR was assessed using linear mixed-effects models. Modified Poisson regression models were employed to assess the associations of cumulative particulate matter exposure with the incidence of chronic kidney disease (CKD). Mediation analyses were used to examine the role of TyG index.

RESULTS

Short-term exposure to particulate matter was related to reduced renal function. The strongest associations between exposure to particulate matter (PM) 1 , PM 2.5 , and PM 10 and percentage changes in eGFR were observed at 7-day moving average exposure windows, with a respective decrease of 0.697% (-1.008%, -0.386%), 0.429% (-0.637%, -0.220%), and 0.373% (-0.581%, -0.164%) per IQR increment. Long-term exposure to PM 1 , PM 2.5 , and PM 10 was positively linked with the incidence of CKD, with each IQR increment corresponding to fully adjusted RRs (95% CIs) of 1.631 (1.446-1.839), 1.599 (1.431-1.787), and 1.903 (1.665-2.175), respectively. TyG index-mediated 8.87, 8.88, and 7.58% of the relationship between cumulative exposure to PM 1 , PM 2.5 , and PM 10 and increased risk of CKD, respectively.

CONCLUSION

Exposure to particulate matter among PWHAs is linked to reduced renal function, potentially contributing to increased CKD incidence, where the TyG index might serve as a partial mediator.

ART and Serum albumin are influencing factors of the 5-year survival rate of people living with HIV undergoing maintenance hemodialysis caused by HIV: A cohort study

Human immunodeficiency virus (HIV) infection is one of the most prominent public health problems worldwide. The 5-year survival rate of people living with HIV undergoing maintenance hemodialysis (MHD) and the factors related to the survival rate have not been widely studied. This study calculated the 5-year survival rate of people living with HIV who were undergoing MHD and determined the risk factors that may affect the 5-year survival rate. All enrolled participants were followed up for more than 5 years from the first round of MHD. The survival rate of them was calculated, the Cox proportional hazards model was used for multivariate analysis, the Kaplan-Meier method was used to draw the survival curve, and the log-rank test was used to compare the survival time of different groups. A total of 121 participants were included in the study. Statistical analysis showed that the overall 5-year survival rate was 19.0%. The 6-, 12-, 24-, and 36-month survival rates were 71.90%, 56.20%, 41.32%, and 30.58%, respectively. Infection was the leading cause of death, accounting for 55.37%. The Cox proportional hazards model revealed that antiretroviral therapy (ART) and the serum albumin level after dialysis were independent protective factors for patient survival. The log-rank test showed that there was a significant difference in survival time between the ART and non-ART groups.

HIV and Associated TB: A Lethal Association for Kidney Health?

Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading infectious causes of death globally. The combined brunt of these diseases is experienced mainly in low-income and lower-middle-income countries. HIV/TB have devastating effects on the kidneys, leading to accelerated decline of kidney function as well as mortality. Managing the triad of TB/HIV and kidney disease is challenging. We discuss the epidemiology of HIV/TB coinfection and the kidney and the key mechanisms of kidney disease including genetic susceptibility. The clinical presentation and pathology, as well as the challenges of diagnosing CKD in these patients, also are discussed. The strategies to prevent and manage HIV/TB-related kidney disease such as proper assessment, avoiding nephrotoxic regimens, drug dose adjustments, kidney function monitoring, avoidance of drug-drug interactions, and other interventions are explored. We also briefly discuss the complexities around HIV/TB patients on dialysis and kidney transplantation. HIV/TB coinfection presents an increased risk for kidney-related morbidity and mortality; patients with this triad need to be given special consideration for future research and management.

HIV Tissue Reservoirs: Current Advances in Research

Acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), has become a heavy burden of disease and an important public health problem in the world. Although current antiretroviral therapy (ART) is effective at suppressing the virus in the blood, HIV still remains in two different types of reservoirs-the latently infected cells (represented by CD4⁺ T cells) and the tissues containing those cells, which may block access to ART, HIV-neutralizing antibodies and latency-reversing agents. The latter is the focus of our review, as blood viral load drops below detectable levels after ART, a deeper and more systematic understanding of the HIV tissue reservoirs is imperative. In this review, we take the lymphoid system (including lymph nodes, gut-associated lymphoid tissue, spleen and bone marrow), nervous system, respiratory system, reproductive system (divided into male and female), urinary system as the order, focusing on the particularity and importance of each tissue in HIV infection, the infection target cell types of each tissue, the specific infection situation of each tissue quantified by HIV DNA or HIV RNA and the evidence of compartmentalization and pharmacokinetics. In summary, we found that the present state of HIV in different tissues has both similarities and differences. In the future, the therapeutic principle we need to follow is to respect the discrepancy on the basis of grasping the commonality. The measures taken to completely eliminate the virus in the whole body cannot be generalized. It is necessary to formulate personalized treatment strategies according to the different characteristics of the HIV in the various tissues, so as to realize the prospect of curing AIDS as soon as possible.

A Systematic Review Exploring the Range of Renal Complications of Human Immunodeficiency Virus

Human immunodeficiency virus (HIV) is a viral infection which progressively leads to acquired immunodeficiency syndrome (AIDS) in the absence of treatment. This happens through the destruction of crucial cells in the immune system, such as the helper T cells, dendritic cells, and macrophages. Since the first case was isolated in the 20th century, the disease has spread rapidly among humans, with significant renal, cardiovascular, respiratory, and neurological complications. It is predominantly sexually transmitted but non-sexual transmission. A relationship between HIV and renal diseases has been suggested for a long time, but only a few systematic studies have centered on this association. This systematic review aims to analyze the possible association between HIV and renal diseases as well as the range and pathogenesis of these renal diseases. HIV remains a critical infectious disease globally, inciting substantial morbidity and mortality. Studies have shown that people living with HIV (PLWH) are at increased risk of acute and chronic kidney disease. This review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Google Scholar, and Cochrane databases were searched exhaustively using the inclusion criteria of free full-text English papers that have exclusively studied humans in the last 20 years. Sixteen articles were selected including a systematic review, observational studies, and comprehensive narrative reviews on the role of HIV in the etiology of renal diseases, and were systemically reviewed and analyzed to elicit the wide range of possible renal complications resulting from HIV infection.

Establishment, Persistence, and Reactivation of Latent HIV-1 Infection in Renal Epithelial Cells

HIV-1 persistence in different cell types presents the main obstacle to an HIV-1 cure. We have previously shown that the renal epithelium is a site of HIV-1 infection and that the kidney represents a separate viral compartment from blood. Whether renal cells can harbor latent virus that can be reactivated upon treatment with latency reversing agents (LRAs) is unknown. To address this question, we developed an in vitro HIV-1 latency model in renal tubule epithelial (RTE) cells using a dual color HIV-1 reporter virus, R7/E-/GFP/EF1a-mCherry (R7GEmC), and evaluated the effect of LRAs, both as single agents and in combination, on viral reactivation. Our data show that HIV-1 can establish latency in RTE cells early postinfection. While the pool of latently infected cells expanded overtime, the percentage of productively infected cells declined. Following LRA treatment only a small fraction of latently infected cells, both T cells and RTE cells, could be reactivated, and the drug combinations more effective in reactivating HIV transcription in RTE cells differed from those more active in T cells. Our study demonstrates that HIV can establish latency in RTE cells and that current LRAs are only marginally effective in inducing HIV-1 reactivation. This suggests that further study of LRA dynamics in non-T cells may be warranted to assess the suitability of LRAs as a sterilizing cure strategy. IMPORTANCE Anti-retroviral therapy (ART) has dramatically reduced HIV-related morbidity and mortality. Despite this success, a number of challenges remain, including the long-term persistence of multiple, clinically latent viral reservoirs capable of reactivation in the absence of ART. As efforts proceed toward HIV eradication or functional cure, further understanding of the dynamics of HIV-1 replication, establishment of latency and mechanisms of reactivation in reservoirs harboring the virus throughout the body is necessary. HIV-1 can infect renal epithelial cells and the expression of viral genes in those cells contributes to the development of HIV associated nephropathy (HIVAN) in untreated individuals. The significance of our work is in developing the first model of HIV-1 latency in renal epithelial cells. This model enhances our understanding of HIV-1 latency and persistence in the kidney and can be used to screen candidate latency reversing agents.

The spectrum of kidney biopsy findings in Chinese HIV-infected patients

OBJECTIVES

HIV-associated kidney disease is common but data on the pathology spectrum of kidney biopsy in China is lacking. This study aimed to illustrate the clinical presentation, laboratory findings and pathological spectrum of different subtypes of HIV-associated kidney disease in China.

METHODS

Eighteen HIV patients with renal biopsy indications at the Peking Union Medical College Hospital from January 2002 to October 2021 were retrospectively enrolled. All had CD4 counts and HIV viral load measurements. Renal biopsies were examined with light microscopy, immunofluorescence, and electron microscopy. Shapiro-Wilk test was used to test whether the data was normally distributed. The data is presented as medians (interquartile range), number (%), or means (±SD) according to their distribution.

RESULTS

Seventeen patients had glomerular disease, and one patient had interstitial nephritis. Membranous nephropathy was present in eight patients (47.1%), and IgA nephropathy in four patients (23.5%). The difference in urine protein and serum albumin before and after treatment was statistically significant and no deaths or dialysis were observed to the end of follow-up.

CONCLUSION

This study found that classic HIV-associated nephropathy (HIVAN) was uncommon in Chinese HIV patients. HIV immune complex kidney (HIVICK) disease, such as membranous or IgA nephropathy, was more common, and associated with better prognosis. Antiretroviral therapy, ACE inhibitors, and angiotensin II receptor blockers were effective in decreasing proteinuria and preserving renal function. The use of corticosteroids and immunosuppressive agents seems safe. However, the nephrotoxic effect of antiretroviral agents and other medications should be carefully monitored.

Analysis of HIV quasispecies and virological outcome of an HIV D+/R+ kidney-liver transplantation

INTRODUCTION

Transplantation among HIV positive patients may be a valuable therapeutic intervention. This study involves an HIV D+/R+ kidney-liver transplantation, where PBMC-associated HIV quasispecies were analyzed in donor and transplant recipients (TR) prior to transplantation and thereafter, together with standard viral monitoring.

METHODS

The donor was a 54 year of age HIV infected woman: kidney and liver recipients were two HIV infected men, aged 49 and 61. HIV quasispecies in PBMC was analyzed by ultra-deep sequencing of V3 env region. During TR follow-up, plasma HIV-1 RNA, HIV-1 DNA in PBMC, analysis of proviral integration sites and drug-resistance genotyping were performed. Other virological and immunological monitoring included CMV and EBV DNA quantification in blood and CD4 T cell counts.

RESULTS

Donor and TR were all ART-HIV suppressed at transplantation. Thereafter, TR maintained a nearly suppressed HIV-1 viremia, but HIV-1 RNA blips and the increase of proviral integration sites in PBMC attested some residual HIV replication. A transient peak in HIV-1 DNA occurred in the liver recipient. No major changes of drug-resistance genotype were detected after transplantation. CMV and EBV transient reactivations were observed only in the kidney recipient, but did not require specific treatment. CD4 counts remained stable. No intermixed quasispecies between donor and TR was observed at transplantation or thereafter. Despite signs of viral evolution in TR, HIV genetic heterogeneity did not increase over the course of the months of follow up.

CONCLUSIONS

No evidence of HIV superinfection was observed in the donor nor in the recipients. The immunosuppressive treatment administrated to TR did not result in clinical relevant viral reactivations.