Principal Investigator(s):
Muktar Aliyu, M.D., M.P.H., Dr.P.H.
William Wester, M.D., M.P.H.
Optimal Management of HIV Infected Adults at Risk for Kidney Disease in Nigeria (U01DK112271-01)
Individuals of African descent face a significantly higher risk for several kidney diseases, such as diabetic nephropathy, hypertension-related kidney disease (arterionephrosclerosis), focal segmental glomerulosclerosis (FSGS), and HIV-associated nephropathy (HIVAN). Research has linked variants in the apolipoprotein-1 (APOL1) gene to increased odds ratios for these conditions, with the risk highest in West Africa, particularly among individuals of Hausa, Fulani, Igbo, and Asante descent.
Markers of kidney disease include microalbuminuria, proteinuria, and reduced estimated glomerular filtration rate (eGFR), all of which are associated with higher mortality in HIV-infected adults. Monitoring urinary albumin can aid in diagnosing and tracking the progression of kidney disease.
The renin-angiotensin-aldosterone system (RAAS) is crucial in chronic kidney disease (CKD) pathology. Blocking RAAS with angiotensin-converting enzyme inhibitors (ACE-I), like lisinopril, is an effective strategy for slowing disease progression. More aggressive RAAS inhibition, such as adding an aldosterone receptor antagonist, may further reduce the risk of kidney complications.
To investigate this high-risk population and identify effective risk-reduction strategies, we plan to screen 2,200 HIV-infected adults on suppressive antiretroviral therapy at Aminu Kano Teaching Hospital. Our objectives are to:
1. Assess the prevalence of APOL1 variants and their correlation with albuminuria, median eGFR, and CKD.
2. Determine if lisinopril significantly reduces the risk of kidney complications compared to a placebo.
3. Evaluate if adding spironolactone to lisinopril provides a more effective strategy for reducing kidney complication risk.