What are HIV-related renal disorders?

Updated: May 09, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Answer

HIV-positive individuals are at increased risk for a variety of renal disorders, including acute kidney injury (AKI), HIV-associated nephropathy (HIVAN), comorbid chronic kidney disease (CKD), and treatment-related kidney toxicity. [1]  HIVAN, the classic kidney disease of HIV infection, has become less common with widespread use of antiretroviral therapy (ART); simultaneously, however, the prevalence of other kidney diseases has increased. [2]

Although combined ART is effective at preventing and reversing HIVAN, long-term use of such therapy has been linked to increased risk for focal segmental glomerulosclerosis, arterionephrosclerosis, and diabetic nephropathy. [3]  Guidelines recommending earlier initiation of ART may further reduce the incidence of HIVAN, but the overall risk-benefit for kidney health is unclear. 

The distribution of HIV-associated kidney diseases continues to vary across geographic regions worldwide. The reasons for this diversity are complex and include a critical role of APOL1 variants and possibly other genetic factors, disparities in access to effective antiviral therapies, and  other risk factors not fully understood. [3]


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