What is HIV-associated nephropathy (HIVAN)?

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

Answer

HIVAN occurs in advanced HIV disease and is classically associated with rapid progression to end-stage renal disease (ESRD).HIVAN almost exclusively affects persons of African descent, who account for approximately 90% of HIVAN-related cases of ESRD. [1]

HIVAN has a distinct histology, representing a collapsing form of focal segmental glomerulosclerosis (FSGS). The pathogenesis of HIVAN requires local HIV infection of the kidney, with the virus infecting tubular and glomerular epithelial cells. Although FSGS is the predominant glomerular lesion in HIVAN, other reported glomerular lesions in patients with HIV include IgA nephropathy, cryoglobulinemia, amyloidosis, and a lupuslike immune complex glomerulopathy. [5]

In addition, as patients with HIV infection age, comorbid kidney diseases such as diabetic nephropathy and arterionephrosclerosis have become increasingly common. When secondary FSGS develops in these patients, the potential overlap with HIVAN can be diagnostically challenging. Kidney biopsy is required to distinguish between these lesions. [4]

For other discussions on management of HIV infection, see HIV Disease, Pediatric HIV Infection, and Antiretroviral Therapy for HIV Infection.

For patient education information, see the Immune System Center and Sexually Transmitted Diseases Center, as well as HIV/AIDS and Rapid Oral HIV Test.


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