Year: 2023
Type: article
Abstract: BACKGROUND: Tubular secretion is an important kidney function responsible for the clearance of numerous medications, including antibiotics and antivirals. It is unknown whether persons living with HIV have lower secretion compared with HIV-uninfected persons, which might predispose them to the risk of progressive kidney disease or adverse drug events. SETTING AND METHODS: We evaluated a panel of 6 endogenous secretory solutes in 199 women living with HIV (WLWH) and 100 women without HIV enrolled in the Women's Interagency HIV Study. Secretory clearance was estimated as the urine-to-plasma ratio of each solute, with adjustment for urine tonicity. Using multivariable linear regression analysis, we compared differences in levels of secretory solute clearance between women with and without HIV and evaluated characteristics associated with secretion. RESULTS: WLWH were older (median 40 vs. 38 years) but had similar estimated glomerular filtration rate (eGFR, 96 vs. 100 mL/minute/1.73 m 2 ) compared with those without HIV. African American and Latino race, diabetes, diastolic blood pressure, smoking, hepatitis C, peak HIV viral load, and current and nadir CD4 count were associated with differences in clearance of at least 1 marker after multivariable adjustment. The secretory clearance of 3 solutes (cinnamoylglycine, kynurenic acid, and pyridoxic acid) were on average 10%-15% lower among WLWH compared with those without HIV independent of eGFR, albuminuria and chronic kidney disease risk factors, including HCV, and injection drug use. CONCLUSIONS: HIV is associated with reduced secretion among women with preserved eGFR. The implications of these findings for drug dosing and adverse events need to be evaluated.
Institutions: University of California San Diego, San Francisco VA Medical Center, University of California, San Francisco, University of Washington, San Francisco VA Health Care System, State University of New York, SUNY Downstate Health Sciences University, University of Southern California, Albert Einstein College of Medicine, John H. Stroger, Jr. Hospital of Cook County, Cook County Health and Hospitals System, University of North Carolina at Chapel Hill, University of Colorado Denver, VA San Diego Healthcare System
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Northwestern University, Georgetown University, Georgia Clinical and Translational Science Alliance, National Institutes of Health, Center for AIDS Research, University of Washington, University of California, San Diego, University of California, San Francisco, Center for AIDS Research, University of Alabama at Birmingham, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Dental and Craniofacial Research, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities, Center for AIDS Research, University of North Carolina at Chapel Hill, Clinical and Translational Science Institute, University of California, Los Angeles
Awards: G1034546755, G12089860, G1296759572, G1329112180, G1400602301, G1655989834, G1787625665, G183157880, G1849940085, G1913134163, G192128497, G2008237588, G2127051194, G2334180555, G248584506, G255204022, G2755707676, G2759654445, G2908277772, G2928778974, G30074556, G311558797, G319781266, G3242306066, G342295615, G343705321, G3630727822, G3671922257, G3789320706, G3869857964, G4010343525, G4016133911, G4044828089, G4391827178, G4535678174, G4559308260, G456742281, G483408255, G495691247, G5078796989, G5147848267, G521591464, G5431849782, G5660189159, G5691055145, G5747858550, G5863844756, G5900455136, G6396423216, G6745172908, G693265041, G6990385686, G7152846654, G7402001664, G775892330, G7807729167, Johns Hopkins Institute for Clinical and Translational Research, G8259150102, UC San Diego Clinical and Translational Research Institute, G9000010044, G9000016284, G9000025681, G9000030772, G9000031392, G9000037749, G9000039899, G9000050451, G9000066220, G9000080293, G9000082816, G9000088144, G9000093720, G9000102070, G9000108991, G9000124410, G9000126122, G9000126231, G9000132212, G9000319632, San Diego Center for AIDS Research (SD CFAR), UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Biomarker-Based Diagnostic Algorithms To Prevent, Detect And Guide Treatment Of Kidney Disease In Persons Living With HIV, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W4361292150