Background: Individuals with two copies of the apolipoprotein-1 (APOL1) gene risk variants are at high risk (HR) for\nnon-diabetic kidney disease. The presence of these risk variants is highest in West Africa, specifically in Nigeria.\nHowever, there is limited availability of dialysis and kidney transplantation in Nigeria, and most individuals will die\nsoon after developing end-stage renal disease. Blocking the renin angiotensin aldosterone system with angiotensinconverting\nenzyme inhibitors (ACEi) is a well-recognized strategy to slow renal disease progression in patients with\ndiabetes mellitus with chronic kidney disease (CKD) and in patients with HIV-associated nephropathy. We propose\nto determine whether presence of the APOL1 HR genotype alters or predicts responsiveness to conventional\ntherapy to treat or prevent CKD and if addition of an ACEi to standard combination antiretroviral therapy (ART)\nreduces the risk of kidney complications among non-diabetic Nigerian adults.\nMethods/design: We will screen 2600 HIV-positive adults who have received ART to (1) determine the prevalence\nof APOL1 risk variants and assess whether APOL1 HR status correlates with prevalent albuminuria, estimated\nglomerular filtration rate (eGFR), and/or prevalent CKD; (2) assess, via a randomized, placebo-controlled trial (RCT) in\na subset of these participants with microalbuminura (n = 280) whether addition of the ACEi, lisinopril, compared to\nstandard of care, significantly reduces the incidence or progression of albuminuria; and (3) determine whether the\nAPOL1 HR genotype is associated with worse kidney outcomes (i.e. eGFR slope or regression of albuminuria) among\nparticipants in the RCT.\nConclusions: This study will examine the increasing prevalence of kidney diseases in HIV-positive adults in a West\nAfrican population, and the relationship between these diseases and the APOL1 high-risk genotype. By evaluating\nthe addition of an ACEi to the care of individuals with HIV infection who have albuminuria, our trial will provide\ndefinitive evidence to guide strategies for management and clinical care in this population, with the goal of\nreducing HIV-related kidney complications.
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