The kidney in HIV infection: beyond HIV-associated nephropathy

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Acute kidney injury (AKI) and chronic kidney disease (CKD) are more prevalent in HIV-infected individuals compared to the general population.
• AKI in HIV patients is often linked to systemic infections and adverse drug reactions, leading to severe health consequences like heart failure, cardiovascular events, end-stage renal disease (ESRD), and mortality.
• The incidence of CKD is increasing among HIV-infected individuals, frequently driven by comorbidities such as diabetes and hypertension.

Purpose of the Study:

• To summarize current understanding and management strategies for AKI and CKD in the context of HIV infection.
• To highlight the importance of revised screening guidelines for CKD in HIV-positive patients.
• To discuss treatment options for ESRD in HIV-infected patients.

Main Methods:

• The content is based on a presentation summarizing clinical case illustrations and current medical knowledge.
• Review of existing literature and clinical guidelines pertaining to kidney disease in HIV.

Main Results:

• AKI in HIV is associated with significant morbidity and mortality.
• CKD prevalence is rising, often due to common comorbidities.
• Current recommendations include creatinine-based glomerular filtration rate and urine protein screening at HIV diagnosis, with annual screening for high-risk individuals.
• Hemodialysis, peritoneal dialysis, and kidney transplantation are viable ESRD treatment options for HIV patients, with transplantation offering intermediate survival rates in selected cases.

Conclusions:

• Kidney diseases, including AKI and CKD, represent a significant health concern for the HIV-infected population.
• Prompt diagnosis through recommended screening protocols and appropriate management of underlying causes and comorbidities are essential.
• Treatment modalities for ESRD, including dialysis and transplantation, are effective in HIV-infected patients, with careful patient selection being key for transplantation success.