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Treatment of HIV-associated nephropathy
J A Winston1, G C Burns, P E Klotman
1Department of Medicine, Mount Sinai School of Medicine, Saint Vincents Hospital Medical Center, New York, NY 10029, USA. Jonathan.Winston@mssm.edu
Insights
HIV-Associated Nephropathy (HIVAN) is a leading cause of kidney failure in HIV-1 patients, particularly Black individuals. Early treatment with highly active antiretroviral therapy (HAART) and converting enzyme inhibitors (CEI) may stabilize kidney function.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- HIV-Associated Nephropathy (HIVAN) is the most common renal complication in HIV-1 infection.
- It disproportionately affects Black individuals aged 20-64, representing a significant cause of end-stage renal disease (ESRD).
- Many patients are diagnosed with an AIDS-defining condition concurrently with HIVAN, progressing rapidly to ESRD without intervention.
Purpose of the Study:
- To review the current understanding of HIV-Associated Nephropathy (HIVAN).
- To discuss treatment strategies including highly active antiretroviral therapy (HAART) and converting enzyme inhibitors (CEI).
- To propose a clinical trial comparing HAART alone versus HAART plus CEI.
Main Methods:
- Review of existing literature on HIVAN pathophysiology and treatment.
- Analysis of the efficacy of HAART, steroids, and CEI in managing HIVAN.
- Proposal for a randomized controlled trial.
Main Results:
- HAART can prolong survival and potentially improve or stabilize kidney function in HIVAN patients.
- Steroids offer short-term benefits, but long-term efficacy is unproven.
- CEI appear to stabilize renal function, especially when initiated early in the disease course.
Conclusions:
- HAART is the cornerstone of HIVAN management.
- Early intervention with CEI may be beneficial in conjunction with HAART.
- A randomized controlled trial is warranted to compare HAART with HAART plus CEI for optimal HIVAN treatment.
Abstract:
HIV-Associated Nephropathy (HIVAN) is the most common cause of chronic renal disease in HIV-1 infected patients. The disease occurs predominantly in blacks between the ages of 20 and 64. In this population it is currently the third leading cause of end-stage renal disease. The majority of patients with HIVAN have an AIDS-defining condition when the kidney disease is diagnosed. Without treatment they progress to end-stage renal disease within weeks to months. Patients with HIVAN should be treated with highly active antiretroviral therapy (HAART). Treatment should prolong survival and may improve or stabilize kidney function. Steroids have short-term benefits but long-term benefits have not been shown. Converting enzyme inhibitors (CEI) seem to stabilize kidney function and appear to be most effective when administered early in the course of HIVAN. A randomized controlled trial comparing HAART therapy to HAART and CEI should be performed.