Prednisone Improves Renal Function and Proteinuria in Human Immunodeficiency Virus-associated Nephropathy

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

“…Furthermore, available data do not allow us to assess the impact of corticosteroids or ACE inhibitors on either patient or renal survival. Reports suggest a beneficial effect on the progression of renal disease among patients with HIVAN with these medications (5,6,8,36), although they have not been tested in prospective, randomized trials. If the benefit of these therapies to renal survival is confirmed, then an increased impact on the incidence of patients who reach ESRD may be observed with their more widespread use.…”

“…Treatment options include steroids, angiotensin-converting enzyme (ACE) inhibitors, and antiretroviral therapy. Although steroids and ACE inhibitors have shown modest success (5,6), antiretroviral therapy, in particular HAART, has demonstrated a beneficial effect on HIV-related renal diseases, including HIVAN (7)(8)(9)(10)(11)(12)(13)(14). This benefit suggests that HAART could potentially slow the progression of HIVAN and other HIV-related renal diseases.…”

In-Depth Review of Human Immunodeficiency Virus-Associated Nephropathy

“…Duration of treatment varied for each patient (range 2 to 26); it was based on the response of serum creatinine, development of steroid-induced side effects or opportunistic infections. However, 19 patients in this study had exposed to at least ARV monotherapy (Smith et al, 1996). Another retrospective study in 21 biopsy-proven HIVAN, treated and controlled groups had non-significant baseline characteristics in term of comorbidities, renal functions, CD4 level, HIV viral load and potential co-founding medications use including ARVs and ACEI, demonstrated preserved renal function and no difference in the incidence of infection or hospitalization in treatment (Eustace et al, 2000).…”

HIV-1 and HIV-Associated Nephropathy 25 Years Later

“…The efficacy of HAART is also consistent with the pathogenic role of direct HIV infection in the development of HIVAN (22). Until recently, the adjunctive use of corticosteroids was not supported by known pathogenic mechanisms, although uncontrolled studies have suggested some improvement in the clinical course of HIVAN (55)(56)(57). Recent in vitro data demonstrate a potential role for inflammatory mediators in the tubulointerstitial compartment (58), providing some scientific rationale for the use of corticosteroids in active disease.…”