Renal disease in patients with HIV infection: Epidemiology, pathogenesis and management

Research output: Contribution to journalArticle

Abstract

With the introduction of highly active antiretroviral therapy, we have witnessed prolonged survival with the potential for normal life expectancy in HIV-infected individuals. With improved survival and increasing age, HIV-infected patients are increasingly likely to experience co-morbidities that affect the general population, including kidney disease. Although HIV-associated nephropathy, the most ominous kidney disease related to the direct effects of HIV, may be prevented and treated with antiretrovirals, kidney disease remains an important issue in this population. In addition to the common risk factors for kidney disease of diabetes mellitus and hypertension, HIV-infected individuals have a high prevalence of other risk factors, including hepatitis C, cigarette smoking and injection drug use. Furthermore, they have exposures unique to this population, including antiretrovirals and other medications. Therefore, the differential diagnosis is vast. Early identification (through efficient screening) and definitive diagnosis (by kidney biopsy when indicated) of kidney disease in HIV-infected individuals are critical to optimal management. Earlier interventions with disease-specific therapy, often with the help of a nephrologist, are likely to lead to better outcomes. In those with chronic kidney disease, interventions, such as aggressive blood pressure control with the use of ACE inhibitors or angiotensin receptor antagonists where tolerated, tight blood glucose control in those with diabetes, and avoidance of potentially nephrotoxic medications, can slow progression and prevent end-stage renal disease. Only with greater awareness of kidney-disease manifestations and their implications in this particularly vulnerable population will we be able to achieve success in confronting this growing problem.

Original languageEnglish (US)
Pages (from-to)963-980
Number of pages18
JournalDrugs
Volume68
Issue number7
DOIs
StatePublished - 2008

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Epidemiology
Kidney Diseases
HIV Infections
Kidney
HIV
AIDS-Associated Nephropathy
Medical problems
Population
Survival
Angiotensin Receptor Antagonists
Highly Active Antiretroviral Therapy
Vulnerable Populations
Hepatitis C
Life Expectancy
Chronic Renal Insufficiency
Angiotensin-Converting Enzyme Inhibitors
Chronic Kidney Failure
Blood Glucose
Diabetes Mellitus
Differential Diagnosis

Keywords

  • HIV 1 infections
  • HIV associated nephropathy, management
  • Kidney disorders, management

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis

Cite this

Renal disease in patients with HIV infection : Epidemiology, pathogenesis and management. / Fine, Derek M; Perazella, Mark A.; Lucas, Gregory M; Atta, Mohamed.

In: Drugs, Vol. 68, No. 7, 2008, p. 963-980.

Research output: Contribution to journalArticle

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