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HIV-associated kidney diseases: progress, gaps, and future directions
Molly C Fisher1, Christina M Wyatt2, Michelle M Estrella3
1Division of Nephrology, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, New York, USA.
Clinical Microbiology Reviews
|November 26, 2025
Summary
Chronic kidney disease (CKD) in people with HIV (PWH) has shifted from HIV-driven causes to age-related conditions like diabetes and hypertension. Early detection and new therapies are crucial for managing CKD and cardiovascular risks in PWH.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Antiretroviral therapy (ART) has transformed HIV care, reducing HIV-associated nephropathy (HIVAN).
- Chronic kidney disease (CKD) is now a significant comorbidity in people with HIV (PWH) due to aging and conditions like diabetes and hypertension.
- CKD management in PWH is complex, especially in low-resource settings with co-infections and limited screening access.
Purpose of the Study:
- To review the current understanding of kidney diseases in people with HIV (PWH).
- To discuss the evolving epidemiology, pathogenesis, diagnosis, and management of CKD in the context of modern HIV care.
- To highlight the importance of early CKD detection and management for preventing progression and cardiovascular complications.
Main Methods:
- Literature review of recent studies on kidney disease in people with HIV (PWH).
- Analysis of epidemiological trends, treatment advancements, and management strategies.
- Synthesis of information on diagnosis, pathogenesis, and outcomes, including kidney transplantation.
Main Results:
- HIV-associated nephropathy (HIVAN) has decreased with widespread ART availability.
- Age-related conditions (diabetes, hypertension) are now primary drivers of CKD in PWH.
- New therapies show promise in reducing CKD progression and cardiovascular events.
- Kidney transplantation offers improved survival for PWH with end-stage kidney disease.
Conclusions:
- CKD remains a critical issue for people with HIV (PWH), driven by comorbidities.
- Early detection, risk factor management, and timely intervention are essential for slowing CKD progression.
- Ongoing research into contemporary ART regimens and novel therapies is needed to further reduce the burden of kidney disease in PWH.
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