Vitamin C dysregulation in HIV: Cross-sectional study of renal leak in women with HIV

Authors

• s Teng
• T Greene
• I Rozga
• R Berman
• PC Violet
• K Wilkins
• M Levine
• I Ebenuwa

Abstract

Background: Reduced plasma vitamin C (vitC) concentrations in HIV may result from abnormal urinary excretion of vitC: a renal leak. Relationships between HIV, renal leak, and plasma vitC concentrations are unknown. We hypothesized that increased renal leak prevalence in HIV would be associated with deficient vitC concentrations.
Methods: We conducted an outpatient cross-sectional convenience sampling study of 96 participants: 40 with HIV (PWH) and 56 without HIV (PWOH). To determine vitC renal leak prevalence, subjects fasted overnight, and matched urine and fasting plasma were collected the following morning. VitC was measured by HPLC with coulometric electrochemical detection. Renal leak was defined as abnormal urinary vitC excretion at fasting plasma concentrations <43.2µM, 2SDs below vitC renal threshold in healthy women. Secondary outcomes assessed group differences in mean plasma vitC concentrations and prevalence of vitC deficiency. Exploratory outcomes assessed clinical parameters associated with renal leak. VitC was measured by HPLC with coulometric electrochemical detection.
Results: PWH had significantly higher renal leak prevalence (73% vs 14%, OR16, p<0.001), lower mean plasma vitC concentrations (14µM vs 50µM, p<0.001), and higher prevalence of vitC deficiency (43% vs 7%, OR10, p<0.001) compared with PWOH. Significant predictors of renal leak included antiretroviral therapy, Black race, older age, and metabolic comorbidities but not viral load or CD4 count. When compared with other chronic disease cohorts, PWH had the highest prevalence of renal leak and vitC deficiency (p<0.001).
Conclusions: High prevalence of vitC renal leak in HIV was associated with vitC deficiency, ART use, and race/ethnic differences.

Scientific Focus Area: Clinical Research

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