HIV-associated renal disease - an overview

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• South Africa has the world's highest HIV rates, significantly impacting kidney health.
• The HIV epidemic was exacerbated by political denialism, leading to delayed interventions.
• A complex interplay of HIV, tuberculosis, and non-communicable diseases like hypertension and diabetes affects renal health.

Purpose of the Study:

• To analyze the impact of the HIV epidemic on kidney disease in South Africa.
• To highlight the challenges and progress in managing HIV-associated kidney conditions.
• To explore potential solutions like ART and transplantation for HIV-positive individuals.

Main Methods:

• Review of recent data from the South African renal registry.
• Analysis of the prevalence of HIV-associated nephropathy (HIVAN) and tuberculosis-related kidney disease.
• Assessment of the impact of antiretroviral therapy (ART) and challenges in diagnosis.

Main Results:

• HIVAN remains prevalent in South Africa, often due to late diagnosis and inadequate renal screening.
• Tuberculosis co-infection contributes to kidney issues like granulomatous interstitial nephritis (GIN) and IRIS.
• Antiretroviral therapy (ART) shows effectiveness in managing HIVAN, but access and adherence remain challenges.

Conclusions:

• Effective ART programs and improved screening for renal disease in HIV-positive individuals are essential.
• Addressing the co-epidemics of HIV, TB, and NCDs is critical for improving kidney outcomes.
• Kidney transplantation from HIV-positive donors to recipients offers a promising avenue for patient care.