HIV-associated nephropathy: Links, risks and management

Laura Palau, Steven Menez, Javier Rodriguez-Sanchez, Tessa Novick, Marco Delsante, Blaithin A. McMahon, Mohamed G. Atta

Research output: Contribution to journalReview articlepeer-review

Abstract

Despite the decreased incidence of human immunodeficiency virus (HIV)-associated nephropathy due to the widespread use of combined active antiretroviral therapy, it remains one of the leading causes of end-stage renal disease (ESRD) in HIV-1 seropositive patients. Patients usually present with low CD4 count, high viral load and heavy proteinuria, with the pathologic findings of collapsing focal segmental glomerulosclerosis. Increased susceptibility exists in individuals with African descent, largely due to polymorphism in APOL1 gene. Other clinical risk factors include high viral load and low CD4 count. Advanced kidney disease and nephrotic range proteinuria have been associated with progression to ESRD. Improvement in kidney function has been observed after initiation of combined active antiretroviral therapy. Other treatment options, when clinically indicated, are inhibition of the renin–angiotensin system and corticosteroids. Further routine management approaches for patients with chronic kidney disease should be implemented. In patients with progression to ESRD, kidney transplant should be pursued, provided that viral load control is adequate. Screening for the presence of kidney disease upon detection of HIV-1 seropositivity in high-risk populations is recommended.

Original languageEnglish (US)
Pages (from-to)73-81
Number of pages9
JournalHIV/AIDS - Research and Palliative Care
Volume10
DOIs
StatePublished - 2018

Keywords

  • APOL1 polymorphism
  • ESRD
  • HIV
  • HIVAN
  • Kidney transplant

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Dermatology
  • Infectious Diseases
  • Virology

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