Renal disease in HIV-infected individuals

Highly active antiretroviral therapy (HAART) has resulted in a marked decrease in AIDS-related conditions and death. With improved survival, cardiovascular disease, hepatic, renal disease, and non-AIDS-related cancers represent an increasing burden for HIV-infected individuals.

HIV-associated nephropathy (HIVAN), acute renal injury, HAART, and comorbid conditions such as hepatitis C, hypertension, and diabetes are among the multiple causes of renal disease. In HIVAN there is incomplete understanding of the interaction of the virus with renal cells and the host genetics leading to susceptibility to this form of renal dysfunction. There is agreement that a baseline estimated glomerular filtration should be obtained and that renal function should be monitored during antiretroviral therapy. There is, however, no agreement as to the most accurate method of estimating GFR. Renal transplantation has emerged as a feasible and successful modality of management of end-stage renal disease (ESRD) in HIV-infected individuals.

Kidney disease represents an increasing concern in the care of HIV-infected persons, although there are questions remaining regarding the pathophysiology of HIVAN. Transplantation, however, can be carried out safely in infected persons with ESRD.