HIV/AIDS--dominant player in chronic kidney disease

HIV-associated nephropathy (HIVAN) is now the third leading cause of end-stage renal disease (ESRD) in African Americans between the ages of 20 and 64 years. Statistics in the United States estimate the incidence of HIVAN to be between 3.5% and 12%. The estimated number of those living with HIV worldwide is 37.4 million, with 26 million in Africa. If the US data for HIVAN were extrapolated to Africa, between 0.9 and 3.1 million people would be predicted to have HIVAN. These figures predict an unprecedented (and possibly underestimated) burden of chronic kidney disease (CKD) in Africa, especially if we take into account the socioeconomic associations with CKD for the African continent. This potentially large number of patients poses daunting logistic, financial, and ethical issues for physicians and nephrologists practicing in Africa. Preventing chronic kidney disease due to HIV in Africa should become a major priority. This would enable early detection and treatment of HIVAN in order to prevent or delay progression to ESRD. As HIV infection is a risk factor for the development of CKD, the HIV Medicine Association of the Infectious Diseases Society of America recommends screening for CKD in HIV-infected patients; screening tests should be similar to those for patients with diabetes mellitus to detect early renal involvement. Preventive strategies need to be determined; prospective studies including antiretroviral therapy, angiotensin-converting enzyme inhibitors, and other therapeutic agents are required.