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2015 ; 4
(3
): 388-95
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Epidemiology, clinical characteristics, and management of chronic kidney disease
in human immunodeficiency virus-infected patients
#MMPMID26167463
Ando M
; Yanagisawa N
World J Nephrol
2015[Jul]; 4
(3
): 388-95
PMID26167463
show ga
Antiretroviral therapy has markedly reduced acquired immune deficiency
syndrome-related deaths and opportunistic infectious diseases. This has resulted
in prolonged survival of individuals infected with the human immunodeficiency
virus (HIV). However, this improvement in survival has been accompanied by an
increase in the incidence of chronic kidney disease (CKD) and end-stage renal
disease. CKD is now epidemic among HIV-infected populations in both Western and
Eastern countries. Risk factors associated with CKD in HIV-infected populations
include aging, hypertension, diabetes mellitus, co-infection with hepatitis C
virus, a low CD4 cell count, and a high HIV viral load. Clinical experience has
shown that HIV-infected individuals often have one or more concurrent risk
factors for CKD. The cumulative effect of multiple risk factors on the
development of CKD should be noted in this population. Glomerular disease
directly related to HIV infection, so-called HIV-associated nephropathy, remains
an important cause of CKD among a limited HIV population of African descent, but
is less likely to be common among other urban HIV populations. The impact of
exposure to nephrotoxic antiretroviral agents on the development of kidney
disease is both an old and a new concern. In particular, the association of
tenofovir with kidney tubular injury has been an area of great interest. The
findings regarding tenofovir's adverse effect on long-term kidney function vary
among studies. The early identification and treatment of CKD is recommended for
reducing the burden of patients requiring dialysis in HIV-infected populations.
Periodic monitoring of urinary concentrations of albumin, protein, and tubular
injury markers such as low-molecular-weight proteins may be useful for the early
diagnosis of patients at risk for incident CKD. This review focuses on recent
epidemiology, clinical characteristics, and management of CKD in a contemporary
HIV-infected population.