HIV-Associated Nephropathy: A Review of the Epidemiology and Clinical Course in the HAART Era

Is There an Epidemic of HIV Infection in the US ESRD Program?

“…Case reports have emphasized the possible reversibility of established HIVAN in patients treated with HAART (12,13). Recent epidemiologic reports have suggested that HAART is associated with decreased prevalence of renal disease and amelioration of progression in the general population and in HIV-infected patients with chronic renal disease (1,2,20,21,(23)(24)(25)(26)(27). The increased prevalence and the decreased incidence of HIV infection in the US ESRD program may reflect earlier and more widespread treatment of patients with HIV infection with HAART, as well as improved survival of HIV-infected ESRD patients.…”

A 20-year history of childhood HIV-associated nephropathy

“…Two other impressive case reports in adults by Wali et al [156] and Winston et al [79], demonstrated that HIV-infected patients with HIVAN-induced renal failure requiring hemodialysis responded dramatically to HAART. Nevertheless, although HAART may improve the outcome of HIVAN by reducing the viral load [157,158], so far it has not been possible to establish a definitive correlation between the regression of HIVAN and suppression of HIV-1 viral load or recovery of CD4 + cells [159]. HIV protease inhibitors may have other beneficial effects that are independent of the suppression of viral load [98,159].…”

Transplantation for Patients Infected with Human Immunodeficiency Virus: No Longer Experimental but Not Yet Routine

“…In the pre-HAART era, the incidence of renal and hepatic failure was greater in HIV-infected individuals than in the HIVnegative population. HIV-infected patients have a high incidence of renal dysfunction and are overrepresented in the population of individuals receiving dialysis [17][18][19][20][21][22][23][24][25][26]. HIV-infected patients receiving dialysis have reduced survival, compared with uninfected patients undergoing dialysis; limited data suggest that HAART somewhat improves the survival of HIVinfected patients receiving dialysis [27][28][29][30][31].…”

“…HIV-infected patients receiving dialysis have reduced survival, compared with uninfected patients undergoing dialysis; limited data suggest that HAART somewhat improves the survival of HIVinfected patients receiving dialysis [27][28][29][30][31]. HIV infection is associated with a spectrum of renal diseases, with a disproportionate impact on black men and injection drug users (as reviewed in [18][19][20][21][22][23][24][25][26] and in [32][33][34]). …”

“…The MELD score is based on 3 biochemical variables-the serum bilirubin level, the serum creatinine level, and the international normalized ratio-and has been shown to be predictive of death 3 months after transplantation among patients with chronic liver disease. For patients without acute hepatic failure who have received liver transplants in the United States during the past year, the median MELD score at the time of transplantation was 22.16 (range, [16][17][18][19][20][21][22][23][24][25][26][27][28] [11]. In regions with severe organ shortages, transplantation may not occur until a MELD score of 25-35 is achieved, which indicates severe organ failure, systemic illness, and/or hepatic malignancy.…”