HIV-related kidney disease has been associated with significant morbidity and mortality in the HIV population. It is clear that the epidemiology of HIV-related kidney disease has changed dramatically since the first case reports in 1984. During these early years, the predominant etiology of kidney disease in HIV was recognized as HIVassociated nephropathy (HIVAN), an aggressive form of kidney disease with a high rate of progression to end-stage renal disease (ESRD). Subsequently, with the widespread use of combination antiretroviral therapy (cART), there was a dramatic decrease in the incidence of ESRD attributed to HIV/AIDS. Although the incidence of HIV-related ESRD has plateaued in the last 15 years, the prevalence has continued to increase because of improved survival. Available prevalence estimates do not include HIV-infected individuals with comorbid ESRD, although there is growing evidence that the epidemiology of kidney disease in the HIV-infected population has changed. This article reviews the impact of risk factors such as race, diabetes mellitus, hypertension, hepatitis C virus coinfection, and the chronic use of cART on the changing epidemiology of HIV-related kidney disease. Additionally in this review, we propose potential areas of translational research that will help to further characterize HIV-related kidney disease in the 21st century.

Thirty years after the discovery of HIV, the epidemic is still a major health concern with no cure in sight. Globally there are regions with concentrated epidemics where high risk groups drive the HIV incidence rates whereas regions with a generalized epidemic have the population at large at risk of HIV acquisition. Current HIV prevention efforts such as HIV testing and counseling, STI treatment and condom use have not been entirely successful. New biomedical interventions have recently shown to be efficacious in the prevention of HIV in specific populations. It is evident that, depending on the population groups driving the epidemic, countries need to take stock of their HIV epidemic and prepare an appropriate response using a combination of current and new biomedical HIV prevention interventions to minimize HIV incidence

Background: This mixed methods study reports on product acceptance from a Phase I clinical trial of a candidate non-nucleoside reverse transcriptase inhibitor (NNRTI) vaginal microbicide product (UC781). The product was evaluated in the context of a Phase I clinical trial in an area characterized by high HIV prevalence among minority women. The findings will inform the development of an acceptable microbicide that will address the needs of diverse women and their partners. Methods: This is a mixed methods study of 34 racially and ethnically diverse female participants and 10 male partners in Atlanta, Georgia. Chi-square tests for marginal homogeneity and kappa statistics were calculated to analyze differences between groups on product attributes and use intention. ANOVA was used to examine difference between the treatment groups. Qualitative data were analyzed via constant comparative methodology. Results: Thirty-four out of the original female cohort of 36 completed the questionnaire. Approval of future microbicide development was high at 91.2% (n=31) despite a lack of enthusiasm for the placebo and UC781 formulations. Overall female acceptability was correlated with personal protection motivation (r=1.00, p<0.001). African American women indicated greater likelihood of post-licensure microbicide use (χ2 (3)=7.9, p=0.048) and ascribed greater importance to its potential protection against HIV (χ2 (4)=18.7, p=0.001) and its potential for dual protection (protective against STIs and/or pregnancy) compared to white women (χ2 (4)=11.3, p=0.024). Men and women supported development in the form of an intravaginal ring or suppository. Men were more likely to encourage female adoption of the method if it afforded HIV protection (r=0.935, p=0.001). Conclusions: Although most women agreed that the development of a microbicide was an important endeavor, quantitative and qualitative data indicated they would not use placebo or UC781 due to the objectionable viscosity, odor, and color. Male partners felt the potential protective benefit of a future microbicide product was its most important feature.

Objectives: Smartphone geosocial networking applications, like Grindr, have become a new context through which young men who have sex with men (YMSM) can meet potential sex partners. Geosocial networking applications move beyond online social networking websites like Facebook by utilizing smartphones’ geo-location functions to facilitate connections with other users based on their current physical location. This study presents data on HIV risk-taking behaviors of YMSM who use Grindr, comparing the sex behaviors with partners met via the application to behaviors with partners met via other means (e.g., a bar, through friends, online). Methods: Utilizing the geo-locating feature of Grindr, 195 YMSM, aged 18 to 24, were randomly recruited based on their location within West Hollywood and Long Beach, CA between August and October, 2011. Participants completed an online survey. Results: YMSM reported using Grindr for entertainment, socializing, partner seeking, and gay community connection. Seventy-five percent of users reported sexual encounters with partners met on Grindr. YMSM reported significantly higher rates of condom use with partners met on Grindr (59.8%) relative to those partners met elsewhere (41.9%). Only 14.7% reported unprotected anal intercourse (UAI) with their last Grindr partner. YMSM who reported UAI with their last partners from Grindr reported significantly more recent male anal sex partners than YMSM who reported no UAI with their last Grindr-met partners. Conclusions: Grindr was used by YMSM for a variety of reasons, and not exclusively for the purpose of sex partner seeking. Overall YMSM who use Grindr practice safer sex with partners met via the application than with partners met elsewhere. YMSM engaging in UAI with partners on Grindr are an especially high-risk group and should be targeted by prevention efforts. Sexual risk behavior with geosocial networking-located partners could be addressed with mobile HIV prevention applications, or within Grindr and other similar applications.

Objectives: We sought to decrease “missed opportunities” for HIV testing by implementing an electronic medical record based intervention designed to increase HIV testing among previously untested men and women ages 18-64 seeking primary medical care in an urban publicly-funded health care system.
Methods: In July 2010, we implemented an electronic medical record based reminder to alert providers to the absence of an HIV test among all patients’ ages 13-64 years old. We compared the rate of missed opportunities for HIV testing among primary care patients seen during the two and a half years before the intervention with that of patients seen during the two years after the intervention was begun. A “missed opportunity” was defined as the failure of a previously untested patient to obtain HIV testing despite having made one or more primary care office visits during a specified time period.
Results: After the implementation of HIV testing reminders, first-time HIV testing increased significantly for both men and women 18-64 years old, resulting in a significant reduction in “missed opportunities.” The intervention was equally effective across different racial and ethnic groups. An increase in new HIV diagnoses after the intervention was observed, consistent with an increase in the number of individuals in the population who received testing.
Conclusions: An electronic medical record-based reminder can significantly increase HIV testing among men and women ages 18-64 who are seeking primary care services.

Despite recent successes in several HIV prevention trials, the epidemic continues to increase in many countries. The most successful biomedical interventions to prevent HIV have been the use of Antiretroviral Therapy (ART) to Prevent Mother-To-Child Transmission (PMTCT), and sexual transmission via microbicides, PreExposure Prophylaxis (PrEP), and treatment of the infected person within discordant couples. In addition medical male circumcision has also been shown to be highly effective in prevention of HIV acquisition. However, emerging data demonstrate that adherence to several of these prevention interventions is critical. ART adherence during and after pregnancy has been shown to be significantly below that recommended for adequate virologic suppression, particularly during the postpartum period. Five recent PrEP trials also demonstrate that the success of PrEP as a public health intervention will necessitate monitoring ART adherence and will include additional interventions to improve or maintain adherence to optimal levels. New successes in HIV prevention research have been tempered by suboptimal adherence. There is a critical need to define practical and effective adherence monitoring strategies as well as controlled trials of adherence interventions in the era of PrEP, Treatment as Prevention (TasP), and PMTCT to maximize their benefit.

We present three cases of HIV-infected patients who developed Fanconi syndrome, hypophosphatemic osteomalacia and bone fractures while on tenofovir, a nucleotide reverse transcriptase inhibitor, commonly used as part of HIV treatment. All patients presented with bone pain, electrolyte and radiographic abnormalities which improved with discontinuation of tenofovir. Although, there have been several studies demonstrating causality between tenofovir and Fanconi syndrome, there are only six previously reported cases of patients developing osteomalacia and fractures since the introduction of tenofovir in 2001. In addition to asymptomatic osteopenia, hypophosphatemic osteomalacia is an important, reversible adverse effect of tenofovir.