Update on Current Management of Chronic Kidney Disease in Patients with HIV Infection

Overview

Journal Int J Nephrol Renovasc Dis

Publisher Dove Medical Press

Specialty Nephrology

Date 2016 Oct 4

PMID 27695357

Citations 20

Authors

Nina E Diana

Saraladevi Naicker

Affiliations

Soon will be listed here.

Abstract

The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN). However, the prevalence of end-stage renal disease in HIV-positive individuals has risen, mainly due to increased longevity on cART. There is a disparity in the occurrence of HIVAN among HIV-positive individuals such that there is an 18- to 50-fold increased risk of developing kidney disease among HIV-positive individuals of African descent aged between 20 and 64 years and who have a poorer prognosis compared with their European descent counterparts, suggesting that genetic factors play a vital role. Other risk factors include male sex, low CD4 counts, and high viral load. Improvement in renal function has been observed after initiation of cART in patients with HIV-associated CKD. Treatment with an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker is recommended, when clinically indicated in patients with confirmed or suspected HIVAN or clinically significant albuminuria. Other standard management approaches for patients with CKD are recommended. These include addressing other cardiovascular risk factors (appropriate use of statins and aspirin, weight loss, cessation of smoking), avoidance of nephrotoxins, and management of serum bicarbonate and uric acid, anemia, calcium, and phosphate abnormalities. Early diagnosis of kidney disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended.

Citing Articles

Chronic kidney disease among people living with HIV on TDF based regimen: A systematic review and meta-analysis.

Yazie T, Shiferaw W, Gebeyehu A, Teshome A, Addisu Z, Belete A PLoS One. 2025; 20(2):e0318068.

PMID: 39913460 PMC: 11801554. DOI: 10.1371/journal.pone.0318068.

Prevalence of and factors associated with chronic kidney disease among patients infected with human immunodeficiency virus attending care and treatment centers at tertiary hospitals in dodoma, Tanzania.

Mwise M, Magoma S, Meremo A Heliyon. 2024; 10(12):e32994.

PMID: 38988569 PMC: 11234037. DOI: 10.1016/j.heliyon.2024.e32994.

Prevalence and Risk Factors for Renal Insufficiency among Adults Living with HIV in Tanzania: Results from a Cross-Sectional Study in 2020-2021.

Ottaru T, Kwesigabo G, Butt Z, Caputo M, Chillo P, Siril H Healthcare (Basel). 2024; 12(6).

PMID: 38540623 PMC: 10970453. DOI: 10.3390/healthcare12060657.

Clinicopathological correlation of kidney disease in HIV infection pre- and post-ART rollout.

Diana N, Davies M, Mosiane P, Vermeulen A, Naicker S PLoS One. 2022; 17(5):e0269260.

PMID: 35639767 PMC: 9154109. DOI: 10.1371/journal.pone.0269260.

Diagnostic accuracy of semiquantitative point of care urine albumin to creatinine ratio and urine dipstick analysis in a primary care resource limited setting in South Africa.

Currin S, Gondwe M, Mayindi N, Chipungu S, Khoza B, Tollman S BMC Nephrol. 2021; 22(1):103.

PMID: 33743616 PMC: 7981803. DOI: 10.1186/s12882-021-02290-5.

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