What is the role of ACE inhibitors in the treatment of 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

In patients with advanced renal insufficiency, captopril was noted to improve renal survival for a mean length of 37-156 days. [18] In a subsequent prospective follow-up of 44 patients, the median length of renal survival for patients who received fosinopril was 479.5 days, with only 1 patient developing ESRD. All untreated control subjects progressed to ESRD, with a median length of renal survival of 146.5 days. [19]

The exact mechanism of action of ACE inhibitors in HIVAN is unknown, but it may be related to a hemodynamic effect, a reduction in the transglomerular passage of serum proteins, and an antiproliferative effect mediated in part by the inhibition of transforming growth factor beta. Use ACE inhibitors if patients do not have hyperkalemia.


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