Urinary albumin excretion is a well-known marker of renal dysfunction and may precede systematic endothelial dysfunction,18 with glomerular permeability to albumin increasing as endothelial dysfunction develops.41 Metabolic syndrome is frequently reported in HIV-infected individuals on ART and is associated with both microalbuminuria and endothelial dysfunction.40 Furthermore, HIV may directly infect the glomerular epithelial cells, resulting in excretion of albumin.42 As tenofovir has nephrotoxic potential,43 it mayfurther augment the effect of the HIV infection on the kidneys. The gene discussed is ALB; the disease is endothelial dysfunction.