Introduction Kidney disease is a well-known and frequent complication of HIV infection. The aim of this study is to investigate novel biomarkers of kidney disease in HIV patients.
Methods This is a cross-sectional study with HIV patients recruited in public health centres in Fortaleza city, Brazil, between January 2016 and March 2017. Three groups of HIV patients were included: I) those who have never received combined antiretroviral therapy (cART), II) those receiving cARTwithtenofovir/lamivudine/efavirenz or III) zidovudine/lamivudine/efavirenz. A group of 13 healthy subjects were the control group. The novel biomarkers investigated were: urinary and serum neutrophil gelatinase-associated lipocalin(uNGAL), urinary monocyte chemoattractant protein-1 (MCP-1) and urinary kidney injure molecule-1 (KIM-1), and the results were compared with the traditional biomarkers microalbuminuria and creatinine. Glomerular filtration rate (GFR) was estimated based on CKD-EPI equation.
Results A total of 66 HIV patients were included, with mean age of 33±8 years, and 77% were male. The majority of the patients (63%) had undetectable viral load. Serum creatinine and GFR were similar in all groups. No HIV patient had GFR <60 mL/min and only two patients (3%) had microalbuminuria >30 mg/g-Cr).KIM-1 levels in patients using Tenofovir were higher than control group (1.25±0.6 vs 0.7±0.2 ng/mg-Cr, p<0.001).MCP-1 was significantly higher among HIV patients, and the highest values were found in those with no cART and high viral load. Urinary NGAL was also higher among HIV patients, but it only presented a tendency to significance (p=0.07). Regarding serum NGAL, no significant difference was observed between the groups (p=0.417). There was significant association between urinary NGAL andmicroalbuminuria (r=0.378, p=0.003) and MCP-1 (r=0.476, p<0.001) in all HIV patients.
Conclusion HIV patients usingcART presents subclinical kidney disease detected through novel biomarkers. KIM-1 may serve as early marker of tenofovir nephrotoxicity, and MCP-1 appears to be related with higher viral load.