“With regard to the mechanisms of chronic systemic inflammation in individuals with chronic, suppressed HIV infection, this is highly complex and not well understood,” Jeffrey Kopp, MD, chief of the Kidney Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases, and the author of an editorial on the Dutch study that also appeared in The Journal of Infectious Diseases, told Contagion. “Multiple mechanisms may contribute, including gut dysfunction, leading to microbial translocation; also, immunosenescence, monocyte activation, dysmetabolism and hypercoagulable state.”Although HIV and its attendant inflammation can cause kidney complications, the treatment for the virus can cause complications as well. Because the older generation of ART was more toxic to the kidneys than newer medications typically prescribed to HIV patients, patients of a certain age (the average age in this study was 52.5 years) are likely to have spent time taking the more harmful drugs. One drug of particular concern is tenofovir disoproxil fumarate (TDF), which was taken by 85% of the study’s participants for an average duration of 4 years and which is known to be associated with proximal renal tubular dysfunction. Previous studies have highlighted the negative effects of tenofovir on the kidneys of HIV-infected patients.