Renal disease and toxicities: issues for HIV care providers

The prevalence of renal disease is increasing in the HIV-infected population, likely reflecting increases in renal disease in the general population due to hypertension and diabetes, clustering of HIV cases in black Americans (who have higher frequency of renal risk factors), and toxicities of antiretroviral and other drugs taken by HIV-infected patients. Screening for renal function and regular follow up are recommended for all HIV-infected individuals starting at the time of HIV diagnosis. Elements of screening include quantitative risk-factor assessment and screening tests, such as urine protein quantitation and estimation of creatinine clearance and glomerular filtration rate. Diagnosis of renal dysfunction includes consideration of causative factors common in the general population as well as HIV-specific factors. This article summarizes a presentation on renal impairment in HIV disease made by Derek M. Fine, MD, at the 9th Annual Ryan White CARE Act Clinical Update in Washington, DC, in August 2006. The original presentation is available as a Webcast at www.iasusa.org.