Résumé
Purpose: To determine the impact of APOL1 high-risk genotype (HR) on kidney function in African HIV+ patients starting a second line antiretroviral treatment (ART).Method: Patients from Africa were randomized to receive one of three second line combinations (randomized phase 3 trial ANRS 12169). In this sub-study, we genotyped the APOL1G1 and G2 risk alleles through Taqman and defined HR by the carriage of two risk alleles (G1/G1, G1/G2 or G2/G2) vs. low-risk genotype (LR: G0/G0, G0/G1 or G0/G2). The kidney function was assessed by the CKD-EPI estimated glomerular filtration rate (eGFR). Logistic regression and mixed linear models were implemented to test the association of APOL1HR with rapid eGFR decline (>5 mL/min/1.73 m²/year) and eGFR evolution over time, respectively.Results: 370 patients (71% female) from Cameroon (294), Burkina Faso (47) and Senegal (29) were included. 27(7.3%) patients had hypertension and 11 (3.0%) had an eGFR<60 mL/min/1.73 m² at baseline. Median (interquartile-range) baseline characteristics were 38.4 (33.2–46.3) yo, 176(78–288) CD4 T-cells/ll, 4.5 (4.1–5.1) log(viral load)/mL and 95.7 (80.9–111.2) mL/min/1.73 m² for eGFR. 12 patients (3.2%) were APOL1HR. Patients were on the second line ART for 57.9 (46.7–64.7) months. During follow-up, eGFR increased of 2 (95% confidence interval [CI], 1.7 to 2.3) mL/min/1.73 m² per year. Patients with baseline high viral load (≥5 log/mL) and APOL1HR had higher risk of rapid decline in eGFR (adjusted OR=24.9[1.5;419.5]) and tend to have a lower improvement in eGFR over time (adjusted b=-3.2[6.8;0.4]mL/min/1.73 m²/year) than patients with baseline low viral load and APOL1LR (figure).Conclusion: Compared to previous reports, the APOL1HR prevalence was low in our cohort (Estrella, 2015; Ekulu, 2019). In patients with baseline high viral load, those with APOL1 HR exhibit a suboptimal improvement in kidney function on second line ART.