# Genetic, Environmental & Histologic Basis for Kidney Disease Risk among Persons Living with HIV

> **NIH NIH R01** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2024 · $624,365

## Abstract

SUMMARY
More than 1.1 million people in the United States (US) are living with human immunodeficiency virus (HIV)
infection, and an estimated 30% of people living with HIV (PLWH) have evidence of chronic kidney disease
(CKD). Compared to the general population, the rate of end-stage renal disease (ESRD) among PLWH is
tenfold greater and mortality on dialysis is 19-fold higher. Contributors to CKD in PLWH include comorbidities
shared with the uninfected population, HIV-specific factors, and genetic variants; however, the interplay of
these various determinants remains incompletely understood. Existing CKD risk prediction tools for PLWH
have low sensitivity and insufficient positive predictive value for clinical decision-making. The ability to risk-
stratify PLWH and distinguish those at highest risk for future development of CKD from those at low risk is
critical to optimize care and patient outcomes. PLWH at high risk can be targeted for interventions to slow CKD
progression and improve survival, including earlier establishment of nephrology care and referral for
transplantation; while identification of those at low risk allows for the development of a living donor selection
framework specific to PLWH, effectively expanding HIV+ to HIV+ transplantation to include living donors. We
hypothesize that the impact of HIV on CKD risk varies by the interplay between comorbid conditions, HIV-
related factors, and genetic variants, and distinct phenotypes of PLWH with high and low CKD risk exist. To
better understand this relationship, we will leverage the Centers for AIDS Research Network of Integrated
Clinical Systems (CNICS), a unique prospective clinical cohort with > 34,000 participants, and will address the
following unique aims: (1) to explore the association of unique HIV-related processes and clinical
characteristics with risk for CKD; (2) to explore the association of genetic variants with risk for CKD and
correlate histologic findings with genetic risk; and (3) develop a tool for predicting CKD risk among PLWH.
Stratification by risk for future development of CKD is critical for identifying those PLWH at highest risk that
would benefit from early nephrology care and referral for transplantation and those at lowest risk that could be
eligible for living kidney donation. Using an existing cohort of PLWH representative of the US HIV population,
with time varying data and DNA for genotyping, to inform CKD risk prediction is necessary, practical, and
novel. Our findings will contribute new insights into the relationship between HIV and risk for kidney disease.

## Key facts

- **NIH application ID:** 10839813
- **Project number:** 5R01DK117675-06
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** JAYME ELIZABETH LOCKE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $624,365
- **Award type:** 5
- **Project period:** 2018-09-01 → 2024-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10839813

## Citation

> US National Institutes of Health, RePORTER application 10839813, Genetic, Environmental & Histologic Basis for Kidney Disease Risk among Persons Living with HIV (5R01DK117675-06). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10839813. Licensed CC0.

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