Kidney Week

Abstract: FR-PO0254

APOL1-Mediated Kidney Disease (AMKD) Progression Among People Living with HIV

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Reed, Rhiannon D., New York University Grossman School of Medicine, New York, New York, United States

Rhiannon D. Reed, DrPH

• Locke, Jayme E., New York University Grossman School of Medicine, New York, New York, United States

Jayme E. Locke, MD, MPH

• Wu, Kana, Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, United States

Kana Wu, PhD

• Johnson, Stacy Alana, Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, United States

Stacy Alana Johnson, MD, PhD

• Yang, Ce, Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, United States

Ce Yang, PhD

• Mgbako, Ofole, New York University Grossman School of Medicine, New York, New York, United States

Ofole Mgbako, MD, MS

• Prakash-Polet, Sindhuri, New York University Grossman School of Medicine, New York, New York, United States

Sindhuri Prakash-Polet, MD, PhD

• Husain, Syed Ali, New York University Grossman School of Medicine, New York, New York, United States

Syed Ali Husain, MD, MA, MPH, FASN

• Saag, Michael, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Michael Saag, MD

• Massie, Allan, New York University Grossman School of Medicine, New York, New York, United States

Allan Massie, PhD

• Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States

Dorry L. Segev, MD, PhD

Background

High-risk APOL1 genotypes are associated with kidney disease and kidney failure in people living with HIV (PLWH). Understanding the disease course of APOL1-mediated kidney disease (AMKD) in this population can inform the development of therapies targeting kidney function preservation. We aimed to describe the trajectory of GFR decline in PLWH with AMKD.

Methods

We identified study participants in the CFAR Network of Integrated Clinical Systems with high-risk APOL1 genotypes (G1/G1, G2/G2, G1/G2), incident proteinuria (first UPCR≥0.2g/g), and eGFR 25- <90 ml/min/1.73m². Participants were categorized by history of type II diabetes mellitus. eGFR slope from onset of proteinuria was estimated using random-coefficient mixed effects models with random intercepts and slopes for each individual and a linear spline at 6 months (to account for potential non-linear trajectory). We also estimated time to end-stage kidney disease (ESKD) and composite endpoint (ESKD, death, sustained eGFR decline ≥ 30%) using Kaplan Meier survival curves.

Results

Among 83 CNICS participants who met inclusion criteria, 18 (22%) had diabetes. At proteinuria onset, non-diabetics were younger and had lower eGFR, higher UPCR, lower BMI, and higher HIV viral load and viral copy-years. In non-diabetics, eGFR slope in the 6 months after proteinuria onset was +14.5/year, then -5.3/year thereafter. In diabetics, eGFR slope was -4.0/year in the first 6 months followed by -6.4/year (Table). Results were similar when restricting follow-up time to 24 or 36 months after incident proteinuria. Event-free survival at 5-years after proteinuria onset was 53.8% among diabetics and 70.2% among non-diabetics (p=0.37) (Figure).

Conclusion

AMKD in PWLH is characterized by rapid kidney function decline, regardless of baseline diabetes status. This period of incident proteinuria may represent the ideal window for therapeutics aimed at halting disease progression.

Funding

• Commercial Support – Vertex Pharmaceuticals