Risk factors for the development of chronic kidney disease with HIV/AIDS

A review of the prevalence and risk factors for chronic kidney disease (CKD) in HIV infection.

A review of published literature.

High risk for development of chronic kidney disease with HIV infection are black race, CD4 count < 200 cells/mm3, HIV RNA levels > 4,000 copies/ml, family history of CKD and presence of diabetes mellitus, hypertension or hepatitis C co-infection. In 2004, the risk of developing ESRD was reported as 50 times higher in HIV-infected African-Americans than in HIV-infected whites and in 2007, African Americans accounted for nearly 90% of ESRD attributed to HIVAN. Once CKD was established, African-Americans were 18 times more likely to progress to ESRD than whites and their decline in GFR was six times more rapid than white subjects. The prevalence of CKD with HIV infection was 3.5 - 4.7% in 31 European countries, Israel and Argentina, and 1.1 - 5.6% Brazil; 18% Switzerland; 27% India and 12.3% Iran. Reported prevalence of CKD in HIV-infected patients in sub-Saharan Africa ranges from 6 - 48.5%. Few renal biopsy studies have been performed. In South Africa, HIVAN was present in variable numbers in three studies, ranging from 5 - 83% and immune complex disease in 21 - 40%. A variation in the MYH9 locus of chromosome 22 has been associated with increased risk for idiopathic FSGS, hypertensive nephrosclerosis and HIVAN and may explain much of the increased risks of ESRD and FSGS among African-Americans. A strong correlation with serum creatinine levels and progression to ESRD in HIV patients has been linked to an index of chronic damage on renal histology.

The role of genetics and variations in MYH9 gene loci in renal disease has to be established in other HIV-infected populations. The histological classification for HIV-associated chronic kidney disease requires review, as well as the utility of chronicity scores to evaluate prognosis and response to therapy of HIV-associated kidney disease.