{"id":3582,"date":"2019-12-05T10:29:19","date_gmt":"2019-12-05T10:29:19","guid":{"rendered":"http:\/\/edren.org\/ren\/education\/textbook\/hiv\/"},"modified":"2020-08-12T11:35:28","modified_gmt":"2020-08-12T11:35:28","slug":"hiv","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/textbook\/conditions-that-affect-the-kidney\/hiv\/","title":{"rendered":"HIV"},"content":{"rendered":"

HIV and the kidney<\/span><\/strong><\/h3>\n

HIV may affect the kidney directly, as may other infections that people with HIV sustain, including Hepatitis viruses and bacterial and other infections.\u00a0 The components of anti-HIV therapy (HAART, Highly Active Anti-Retroviral Therapy) may be nephrotoxic.\u00a0 Reduced GFR is more common in patients with HIV infection, but this is may not be directly related to the HIV virus, but contributed to by the increased prevalence of features of the metabolic syndrome (diabetes, hypertension and dyslipidaemia) that is seen with HAART.<\/p>\n

Classic HIV nephropathy<\/span><\/strong> is a ‘collapsing’ type of FSGS<\/a> that occurs almost exclusively in those with black African ancestry.\u00a0 This susceptibility has been linked to an allele of the ApoL1 gene, which seems to be positively selected for in Africa because it gives protection against Leishmaniasis.\u00a0 HIV-associated FSGS typically presents with proteinuria<\/a>, nephrotic syndrome<\/a> and progressive renal impairment.\u00a0 It is a feature of advanced HIV infection with high viral load and low CD4 count, but it is commonly a presenting feature of HIV infection.\u00a0 The nephropathy appears to respond to HAART if treated early, but often causes ESRF.\u00a0 ACE inhibitors <\/a>and blood pressure<\/a> control are as important as they are in all glomerular diseases.<\/p>\n

Other glomerulopathies<\/span><\/strong>\u00a0of diverse types have an increased in incidence in HIV infection, and are a more common diagnosis in non-black races.\u00a0 These are often associated with immune deposits and where they do not clearly fall into a clear other diagnostic category they may be termed HIVICK, HIV Immune Complex Kidney disease.\u00a0 This may be related to infection with HIV itself or to coinfection with other organisms, while some may be autoimmune in etiology.\u00a0 HAART is a logical response in addition to ACE inhibition and blood pressure control.<\/p>\n

Drug effects <\/span><\/strong>–\u00a0 several anti-HIV drugs are known to be nephrotoxic.\u00a0 Indinavir is prone to form crystals, and acute crystalluria can cause acute renal failure.\u00a0 Tenofivir and others are associated with interstitial renal disease, and tenofivir may cause damage to proximal tubules leading to renal Fanconi syndrome (low phosphate caused by phosphaturia, along with glycosuria with normal blood sugar, and amino aciduria).<\/p>\n

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Other issues<\/span><\/strong><\/h3>\n

Patients in low-resource environments with HIV often have reduced GFR and are at risk of incorrect dosing of all drugs, and of side effects with some anti-HIV drugs. \u00a0Multiple drugs for HIV as well as for other infections such as TB increase the likelihood of drug interactions and toxicity.<\/p>\n

Renal replacement therapy by dialysis and\/or transplantation can be successful in patients in whom HAART has successfully lowered viral titres and allowed recovery of CD4 counts.<\/p>\n

 <\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

HIV and the kidney HIV may affect the kidney directly, as may other infections that people with HIV sustain, including Hepatitis viruses and bacterial and other infections.\u00a0 The components of anti-HIV therapy (HAART, Highly Active Anti-Retroviral Therapy) may be nephrotoxic.\u00a0 Reduced GFR is more common in patients with HIV infection,\u2026<\/p>\n

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