Highly Active Antiretroviral Therapy and the Epidemic of HIV+ End-Stage Renal Disease

Abstract

The rise in the number of patients with HIV-associated nephropathy and HIV-infection with end-stage renal disease (HIV؉ ESRD) continues to be a substantial concern for the ESRD program. In order to assess the impact of highly active antiretroviral therapy (

Racial Differences in End-Stage Renal Disease Rates in HIV Infection versus Diabetes

“…14 Our results demonstrate an excess risk for ESRD among black individuals with HIV and therefore lend support to projected increases in the size of the HIV-infected ESRD population. 3 Furthermore, the World Health Organization reported that in 2006, 24.7 million people (63% of all people with HIV infection) were living with HIV in sub-Saharan Africa. 15 Kidney biopsy studies have revealed that HIV-infected patients in Africa exhibit similar renal disease patterns compared with black individuals who live in the United States, France, and Brazil.…”

“…1 The number of HIV-infected patients with ESRD doubled between 1995 and 2000, and HIV-associated nephropathy is the third leading cause of ESRD among black individuals in the United States who are aged 20 to 64 yr. 2 Although the prevalence of ESRD in the HIV-infected population is projected to increase, 3 very few studies have attempted to define the importance of HIV as a risk factor for progression of renal disease. Because of the rarity of ESRD as a clinical outcome, previous studies relied on surrogate measures for renal disease progression, such as increases in creatinine or the development of proteinuria.…”

“…4,5 Furthermore, few studies have provided contemporary estimates of the risk for ESRD among HIV-infected patients since the advent of antiretroviral therapy. 3,6 To better understand the effect of HIV on progression of renal disease, we examined the incidence of ESRD in a national cohort of US veterans. To place our results in context, we compared the risk for ESRD associated with HIV with that of diabetes, a widely recognized risk factor for ESRD.…”

In-Depth Review of Human Immunodeficiency Virus-Associated Nephropathy

“…Originally, it was named AIDS-nephropathy; however, because renal histopathologic defective findings were demonstrated in asymptomatic patients, the name was changed to HIVAN. Collapsing Focal Segmental Glomerulosclerosis (FSGS) with tubulointerstitial lesions, the classical histopathologic pattern in HIVAN is more prevalent in patients of African descent (Lucas et al, 2004;Lescure et al, 2012;Schwartz et al, 2005). At present, medical laboratories and clinical societies have focused on host genetic factors and complex host-viral genetic interactions to understand the pathogenesis of this disease among various populations and to develop potentially effective therapy.…”

Diffuse Tubulointerstitial Nephritis Accompanied by Renal Crystal Formation in an HIV-infected Patient Undergoing Highly Active Antiretroviral Therapy

“…HAART has prevented HIVAN and has led to a decline in the mortality of HIV infection. However, the frequency of chronic renal disease has paradoxically increased in HIV-positive patients despite receiving HAART, and also a variety of adverse renal effects of HAART have been recognized (3,4). Some antiretroviral drugs may have life threatening side effects, especially if underlying renal abnormalities exist.…”