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Linking Predation Risk, Herbivore Physiological Stress and Microbial Decomposition of Plant Litter
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HIV-associated nephropathy: links, risks and management.

Laura Palau1, Steven Menez1, Javier Rodriguez-Sanchez1

  • 1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.

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|June 7, 2018
PubMed
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Human immunodeficiency virus (HIV)-associated nephropathy still causes end-stage renal disease (ESRD) in HIV-1 patients. Antiretroviral therapy improves kidney function, but genetic factors like APOL1 increase risk.

Keywords:
APOL1 polymorphismESRDHIVHIVANkidney transplant

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Genetics

Background:

  • HIV-associated nephropathy (HIVAN) remains a significant cause of end-stage renal disease (ESRD) in HIV-1 seropositive individuals.
  • Despite advances in antiretroviral therapy, HIVAN pathogenesis involves complex interactions between the virus, host genetics (particularly APOL1), and immune response.
  • Clinical presentation often includes low CD4 counts, high viral loads, and heavy proteinuria, with characteristic collapsing focal segmental glomerulosclerosis on biopsy.

Purpose of the Study:

  • To review the current understanding of HIVAN epidemiology, risk factors, clinical presentation, and management strategies.
  • To highlight the role of APOL1 gene polymorphism in increased susceptibility to HIVAN, especially in individuals of African descent.
  • To emphasize the importance of early detection, comprehensive management, and consideration of kidney transplantation in advanced cases.

Main Methods:

  • Literature review of studies on HIVAN, antiretroviral therapy, APOL1 nephropathy, and kidney disease management in HIV-1 patients.
  • Analysis of clinical data regarding risk factors, diagnostic findings, and treatment outcomes.
  • Synthesis of current guidelines and recommendations for managing HIV-associated kidney disease.

Main Results:

  • Combined active antiretroviral therapy has decreased HIVAN incidence but it remains a leading cause of ESRD in HIV-1 patients.
  • APOL1 gene polymorphism significantly increases the risk of developing HIVAN, particularly in individuals of African ancestry.
  • Advanced kidney disease and nephrotic proteinuria are associated with progression to ESRD, while effective antiretroviral therapy can improve kidney function.

Conclusions:

  • Early screening for kidney disease in HIV-1 positive individuals, especially those with risk factors like low CD4 count, high viral load, and APOL1 variants, is crucial.
  • Management should include optimizing antiretroviral therapy, renin-angiotensin system inhibition, corticosteroids when indicated, and standard chronic kidney disease care.
  • Kidney transplantation is a viable option for patients with ESRD, contingent on adequate viral load control.