Childhood HIV-associated nephropathy: 36 years later

Area of Science:

• Nephrology
• Infectious Diseases
• Genetics

Background:

• HIV-associated nephropathy (HIVAN) primarily impacts individuals of African ancestry with HIV, particularly those without effective antiretroviral therapy (ART).
• Childhood HIVAN presents with significant proteinuria, impaired kidney function, and characteristic histological changes including glomerulosclerosis and tubular dilatation.
• Pathogenesis involves inflammatory cell infiltration, kidney epithelial cell infection, and contributions from viral (e.g., HIV-Tat gene) and genetic factors (e.g., APOL1 risk variants).

Purpose of the Study:

• To review recent advancements in understanding the pathogenesis and treatment of childhood HIVAN over the past decade.
• To highlight the mechanisms of kidney epithelial cell infection and the roles of cytokines, HIV-Tat, and APOL1 gene variants.

Main Methods:

• Literature review focusing on studies published within the last 10 years.
• Analysis of research on HIVAN pathogenesis, including viral and genetic factors.
• Examination of treatment strategies and outcomes for childhood HIVAN.

Main Results:

• Modern ART has reduced the incidence and improved outcomes of childhood HIVAN.
• Despite ART improvements, challenges remain in chronic treatment adherence for pediatric populations.
• Key pathogenic mechanisms include inflammatory responses, epithelial cell susceptibility, and genetic predispositions like APOL1 variants.

Conclusions:

• Understanding the complex interplay of viral, genetic, and inflammatory factors is critical for managing childhood HIVAN.
• Enhanced prevention and treatment programs are essential to combat HIVAN in children living with HIV.
• Further research is needed to optimize long-term ART adherence and develop targeted therapies for HIVAN.