Abstract
INTRODUCTION: Human immunodeficiency virus (HIV) remains a worldwide disease with significant mortality and morbidity. There are a multitude of HIV-related kidney diseases including HIV-associated nephropathy (HIVAN) most prominently. The risk of developing HIVAN increases with decreasing CD4 count, higher viral load, and based on genetic factors. The mortality rate for those with HIVAN-end stage renal disease (ESRD) remains 2.5-3 times higher than ESRD patients without HIVAN. Areas covered: The epidemiology of HIVAN, particularly risk assessment, will be explored in this review. Further, the pathogenesis of HIVAN, from viral-specific renal expression to the role of genetics as well as characteristic renal pathology will be described. Diagnosis and management of HIVAN will be addressed, with an emphasis on various treatment strategies including medication, dialysis, and kidney transplantation. Expert opinion: HIVAN is associated with a high risk for progression to ESRD and increased mortality. The backbone of HIVAN therapy remains combined anti-retroviral therapy (cART), while adjunctive therapies including RAAS blockade and prednisone, should be considered. In those who progress to ESRD, dialysis remains the mainstay of management, though increasing evidence has demonstrated that kidney transplantation can be effective in those with controlled HIV disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 39-48 |
| Number of pages | 10 |
| Journal | Expert Opinion on Pharmacotherapy |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2018 |
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Keywords
- dialysis
- ESRD
- HIV
- HIVAN
- kidney biopsy
- transplantation
ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
Cite this
Pharmacotherapy and treatment options for HIV-associated nephropathy. / Menez, Steven; Hanouneh, Mohamad; McMahon, Blaithin A.; Fine, Derek M; Atta, Mohamed.
In: Expert Opinion on Pharmacotherapy, Vol. 19, No. 1, 01.01.2018, p. 39-48.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Pharmacotherapy and treatment options for HIV-associated nephropathy
AU - Menez, Steven
AU - Hanouneh, Mohamad
AU - McMahon, Blaithin A.
AU - Fine, Derek M
AU - Atta, Mohamed
PY - 2018/1/1
Y1 - 2018/1/1
N2 - INTRODUCTION: Human immunodeficiency virus (HIV) remains a worldwide disease with significant mortality and morbidity. There are a multitude of HIV-related kidney diseases including HIV-associated nephropathy (HIVAN) most prominently. The risk of developing HIVAN increases with decreasing CD4 count, higher viral load, and based on genetic factors. The mortality rate for those with HIVAN-end stage renal disease (ESRD) remains 2.5-3 times higher than ESRD patients without HIVAN. Areas covered: The epidemiology of HIVAN, particularly risk assessment, will be explored in this review. Further, the pathogenesis of HIVAN, from viral-specific renal expression to the role of genetics as well as characteristic renal pathology will be described. Diagnosis and management of HIVAN will be addressed, with an emphasis on various treatment strategies including medication, dialysis, and kidney transplantation. Expert opinion: HIVAN is associated with a high risk for progression to ESRD and increased mortality. The backbone of HIVAN therapy remains combined anti-retroviral therapy (cART), while adjunctive therapies including RAAS blockade and prednisone, should be considered. In those who progress to ESRD, dialysis remains the mainstay of management, though increasing evidence has demonstrated that kidney transplantation can be effective in those with controlled HIV disease.
AB - INTRODUCTION: Human immunodeficiency virus (HIV) remains a worldwide disease with significant mortality and morbidity. There are a multitude of HIV-related kidney diseases including HIV-associated nephropathy (HIVAN) most prominently. The risk of developing HIVAN increases with decreasing CD4 count, higher viral load, and based on genetic factors. The mortality rate for those with HIVAN-end stage renal disease (ESRD) remains 2.5-3 times higher than ESRD patients without HIVAN. Areas covered: The epidemiology of HIVAN, particularly risk assessment, will be explored in this review. Further, the pathogenesis of HIVAN, from viral-specific renal expression to the role of genetics as well as characteristic renal pathology will be described. Diagnosis and management of HIVAN will be addressed, with an emphasis on various treatment strategies including medication, dialysis, and kidney transplantation. Expert opinion: HIVAN is associated with a high risk for progression to ESRD and increased mortality. The backbone of HIVAN therapy remains combined anti-retroviral therapy (cART), while adjunctive therapies including RAAS blockade and prednisone, should be considered. In those who progress to ESRD, dialysis remains the mainstay of management, though increasing evidence has demonstrated that kidney transplantation can be effective in those with controlled HIV disease.
KW - dialysis
KW - ESRD
KW - HIV
KW - HIVAN
KW - kidney biopsy
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=85043369107&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85043369107&partnerID=8YFLogxK
U2 - 10.1080/14656566.2017.1416099
DO - 10.1080/14656566.2017.1416099
M3 - Review article
C2 - 29224373
AN - SCOPUS:85043369107
VL - 19
SP - 39
EP - 48
JO - Expert Opinion on Pharmacotherapy
JF - Expert Opinion on Pharmacotherapy
SN - 1465-6566
IS - 1
ER -