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Background: HIV-positive adults are at risk for various kidney diseases, and apolipoprotein 1 (APOL1) high-risk genotypes increase this risk. This study aimed to determine the prevalence and ethnic distribution of APOL1 risk genotypes among a cohort of HIV-positive Nigerian adults and to explore the relationship between APOL1 risk variant status and albuminuria and estimated glomerular filtration rate (eGFR). Methods: We conducted a cross-sectional study among 2458 persons living with HIV who attended an HIV clinic in northern Nigeria and had received antiretroviral therapy (ART) for a minimum of six months. We collected two urine samples 4-8 weeks apart to measure albumin excretion, and blood samples to measure eGFR and determine APOL1 genotype. Findings: The frequency of the APOL1 high-risk (HR) genotype was 6·2%, which varied by ethnic group: Hausa/Fulani (2%), Igbo (49·1%), and Yoruba (14·5%). The prevalence of microalbuminuria (urine/albumin creatinine ratio [uACR] 30 – 300 mg/g) was 37%, and the prevalence of macroalbuminuria (uACR > 300 mg/g) was 3%. The odds of microalbuminuria and macroalbuminuria were higher for participants with the APOL1 HR genotype compared to those carrying the low-risk (LR) genotype (aOR = 1·97, 95% confidence interval [CI] 1·38-2·82; aOR = 4·01, 95% CI 1·98-8·12; respectively). APOL1 HR genotype participants were also at higher risk of having both eGFR 300 mg/g (aOR = 5·85, 95% CI 1·66-20·62). Interpretation: We found a high proportion of HIV-positive, ART-experienced, and largely virologically suppressed adults had microalbuminuria. Although the high-risk APOL1 genotype was less prevalent than expected, it was strongly associated with albuminuria. Future investigations are needed to determine the etiology of the high rate of microalbuminuria in this population within the context of controlled HIV infection and to determine long-term kidney outcomes. Trial Registration: The study was registered with clinicaltrials.gov (NCT03201939) and the Pan African Clinical Trials Registry (PACTR201711002808414). Funding Statement: This work is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), U01 DK112271. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study was approved by the Institutional Review Board of Vanderbilt University Medical Center (FWA00005756) and the Ethics Committee of AKTH (FWA00026225).

It is unclear whether metabolic syndrome (MetS) is associated with atrial fibrillation (AF) in an older population with greater cardiovascular risk, including those with chronic kidney disease. The authors investigated the association between MetS and AF in participants in SPRINT (Systolic Blood Pressure Intervention Trial). MetS was defined based on the Modified Third National Cholesterol Education Program. The baseline prevalence rate for MetS was 55%, while 8.2% of the participants had AF. In multivariate regression analyses, AF was not associated with presence of MetS in either chronic kidney disease or non–chronic kidney disease subgroups. Age, race, history of cardiovascular diseases, decreased triglycerides, decreased pulse pressure, and albuminuria remained significantly associated with AF risk. In contrast to the general population, MetS was not associated with AF in the older population with increased cardiovascular risk studied in SPRINT.

Introduction The effect of intensive blood pressure control upon erectile function in men with hypertension, but without diabetes, is largely unknown. Aim To examine the effects of intensive systolic blood pressure (SBP) lowering on erectile function in a multiethnic clinical trial of men with hypertension. Methods We performed subgroup analyses from the Systolic Blood Pressure Intervention Trial ([SPRINT]; ClinicalTrials.gov: NCT120602, in a sample of 1255 men aged 50 years or older with hypertension and increased cardiovascular disease risk. Participants were randomly assigned to an intensive treatment group (SBP goal of Main Outcome Measure The main outcome measure was change in erectile function from baseline, using the 5-item International Index of Erectile Function (IIEF-5) total score, and erectile dysfunction ([ED]; defined as IIEF-5 score ≤21) after a median follow-up of 3 years. Results At baseline, roughly two-thirds (66.1%) of the sample had self-reported ED. At 48 months after randomization, we determined that the effects of more intensive blood pressure lowering were significantly moderated by race-ethnicity (p for interaction = 0.0016), prompting separate analyses stratified by race-ethnicity. In non-Hispanic whites, participants in the intensive treatment group reported slightly, but significantly better change in the IIEF-5 score than those in the standard treatment group (mean difference = 0.67; 95% CI = 0.03, 1.32; P = 0.041). In non-Hispanic blacks, participants in the intensive group reported slightly worse change in the IIEF-5 score than those in the standard group (mean difference = −1.17; 95% CI = −1.92, −0.41; P = 0.0025). However, in non-Hispanic whites and non-Hispanic blacks, further adjustment for the baseline IIEF-5 score resulted in nonsignificant differences (P > 0.05) according to the treatment group. In Hispanic/other participants, there were no significant differences in change in the IIEF-5 score between the two treatment groups (P = 0.40). In a subgroup of 280 participants who did not report ED at baseline, the incidence of ED did not differ in the two treatment groups (P = 0.53) and was without interaction by race-ethnicity. Clinical Implications The effect of intensive treatment of blood pressure on erectile function was very small overall and likely not of great clinical magnitude. Strength & Limitations Although this study included a validated measure of erectile function, testosterone, other androgen, and estrogen levels were not assessed. Conclusion In a sample of male patients at high risk for cardiovascular events but without diabetes, targeting a SBP of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in statistically significant effects on erectile function that differed in accordance with race-ethnicity, although the clinical importance of the differences may be of small magnitude.