TY - JOUR
T1 - HIV-associated nephropathy
T2 - Epidemiology pathogenesis diagnosis and management
AU - Atta, Mohamed G.
AU - Lucas, Gregory M.
AU - Fine, Derek M.
N1 - Funding Information:
In the pre-HAART era, HIV-1 infection was an absolute contraindication for organ transplantation in the majority of medical centers in the USA. Currently however, improvement in the overall survival rate of HIV-infected individuals has resulted in organ transplantation emerging as a potential therapeutic option for those with end-organ failure. HIV-1-infected individuals with ESRD are considered renal transplant candidates if their CD4 count is at least 200 cells/mm3 and HIV-1 is undetectable. Given the absence of long-term data regarding the complexity of HAART regimens, and frequent drug interactions with immunosuppressive medications, a multisite study sponsored by the University of California, San Francisco (CA, USA) and supported by the NIH, has been launched in the USA to explore safety and efficacy of solid organ transplantation in HIV-1-infected individuals with end-organ damage. This nationally coordinated effort will ultimately provide much needed data on graft survival, drug interactions, optimal immunosuppressive therapy and potential complications in this population. It will also provide the basis for future development of clinical practice guidelines in managing transplant recipients with HIV-1 infection.
PY - 2008/6
Y1 - 2008/6
N2 - HIV-associated nephropathy (HIVAN) is the most well-known and aggressive kidney disease in HIV-1-infected patients. A variant of focal segmental glomerulosclerosis, it is characterized by the collapse of the glomerular tuft with podocyte hypertrophy/hyperplasia and foot process effacement, often with concurrent tubular microcystic dilation and tubulointerstitial nephritis. The disease has been intimately linked to the direct effect of HIV-1 on the kidney. It affects patients of African descent exclusively and is manifested by an acute decline in kidney function, most often in conjunction with high-grade proteinuria and uncontrolled HIV-1 infection. With the widespread use of highly active antiretroviral therapy (HAART), its prevalence is declining in Western countries. However, the epidemiology of the disease is not well defined in the poorest areas of the world, which bear a disproportionate share of the HIV-1 epidemic burden. Scientific evidence suggests that HAART can prevent the development of HIVAN. Furthermore, HAART corticosteroids and inhibition of the renin-angiotensin axis are potentially helpful in delaying disease progression, as well as the need for renal replacement therapy.
AB - HIV-associated nephropathy (HIVAN) is the most well-known and aggressive kidney disease in HIV-1-infected patients. A variant of focal segmental glomerulosclerosis, it is characterized by the collapse of the glomerular tuft with podocyte hypertrophy/hyperplasia and foot process effacement, often with concurrent tubular microcystic dilation and tubulointerstitial nephritis. The disease has been intimately linked to the direct effect of HIV-1 on the kidney. It affects patients of African descent exclusively and is manifested by an acute decline in kidney function, most often in conjunction with high-grade proteinuria and uncontrolled HIV-1 infection. With the widespread use of highly active antiretroviral therapy (HAART), its prevalence is declining in Western countries. However, the epidemiology of the disease is not well defined in the poorest areas of the world, which bear a disproportionate share of the HIV-1 epidemic burden. Scientific evidence suggests that HAART can prevent the development of HIVAN. Furthermore, HAART corticosteroids and inhibition of the renin-angiotensin axis are potentially helpful in delaying disease progression, as well as the need for renal replacement therapy.
KW - End-stage renal disease
KW - HIV-1
KW - HIV-associated nephropathy
KW - Highly active antiretroviral therapy
KW - Kidney
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U2 - 10.1586/14787210.6.3.365
DO - 10.1586/14787210.6.3.365
M3 - Review article
C2 - 18588500
AN - SCOPUS:48449099382
SN - 1478-7210
VL - 6
SP - 365
EP - 371
JO - Expert Review of Anti-Infective Therapy
JF - Expert Review of Anti-Infective Therapy
IS - 3
ER -