Kidney Disease in HIV: Moving beyond HIV-Associated Nephropathy

In developed countries, remarkable advances in antiretroviral therapy have transformed HIV infection into a chronic condition. As a result, HIV-associated nephropathy, the classic HIV-driven kidney lesion among individuals of African descent, has largely disappeared in these regions. However, HIV-po...

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Published in:Journal of the American Society of Nephrology Vol. 28; no. 11; p. 3142
Main Authors: Jotwani, Vasantha, Atta, Mohamed G, Estrella, Michelle M
Format: Journal Article
Language:English
Published: United States 01.11.2017
Subjects:
AIDS-Associated Nephropathy - etiology
Anti-Retroviral Agents - adverse effects
Apolipoprotein L1
Apolipoproteins - genetics
HIV Infections - complications
HIV Infections - drug therapy
Humans
Kidney Transplantation
Lipoproteins, HDL - genetics
Renal Insufficiency, Chronic - etiology
Renal Insufficiency, Chronic - genetics
Renal Insufficiency, Chronic - surgery
Risk Factors
Tenofovir - adverse effects
chronic kidney disease
HIV nephropathy
Apolipoprotein L1
ISSN:1533-3450, 1533-3450
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Summary:In developed countries, remarkable advances in antiretroviral therapy have transformed HIV infection into a chronic condition. As a result, HIV-associated nephropathy, the classic HIV-driven kidney lesion among individuals of African descent, has largely disappeared in these regions. However, HIV-positive blacks continue to have much higher rates of ESRD than HIV-positive whites, which could be attributed to the renal risk variants. Additionally, HIV-positive individuals face adverse consequences beyond HIV itself, including traditional risk factors for CKD and nephrotoxic effects of antiretroviral therapy. Concerns for nephrotoxicity also extend to HIV-negative individuals using tenofovir disoproxil fumarate-based pre-exposure prophylaxis for the prevention of HIV infection. Therefore, CKD remains an important comorbid condition in the HIV-positive population and an emerging concern among HIV-negative persons receiving pre-exposure prophylaxis. With the improved longevity of HIV-positive individuals, a kidney transplant has become a viable option for many who have progressed to ESRD. Herein, we review the growing knowledge regarding the renal risk variants in the context of HIV infection, antiretroviral therapy-related nephrotoxicity, and developments in kidney transplantation among HIV-positive individuals.
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ISSN:1533-3450
1533-3450
DOI:10.1681/ASN.2017040468