[HIV infection and associated kidney disease]

A wide spectrum of kidney diseases is observed in patients with HIV infection and renal involvement. After the introduction of highly active antiretroviral treatment (ART), the survival of patients has increased and the pattern of chronic kidney diseases changed. There has been a reduction in the prevalence of diseases more strictly related to HIV infection and an increase in comorbid conditions like diabetic nephropathy, nephroangiosclerosis, HCV hepatitis and drug-related tubulointerstitial nephritis, in particular related to antiretroviral drugs. Among the glomerular diseases four groups can be identified: 1) HIV-associated nephropathy (HIVAN), a severe collapsing glomerulosclerosis; 2) immune-complex glomerulonephritis (ICGN), including many varieties; 3) various non-HIVAN, non-ICGN glomerular diseases; 4) thrombotic microangiopathy. Moreover, acute and chronic tubulointerstitial nephritis has been found to occur. The pathogenesis of HIVAN is due to direct infection of cells, in particular podocytes, by HIV or its viral products. Genetic predisposition plays an important role in HIVAN. The treatment of HIV-related glomerulonephritis is mainly based on prolonged use of ART associated with ACE inhibitors. We have studied a series of 93 patients with HIV infection and kidney disease who underwent renal biopsy in a single nephrology center. Eighty-seven patients had glomerular diseases, among which six cases of thrombotic microangiopathy. Coinfection with HCV was present in 60% of patients with glomerulonephritis. Moreover, we observed six cases of tubulointerstitial nephritis. Dialysis and transplantation can be safely performed in uremic HIV patients without any major complications. ART is used to improve their survival.