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Review
. 2018 Jan;19(1):39-48.
doi: 10.1080/14656566.2017.1416099. Epub 2017 Dec 26.

Pharmacotherapy and treatment options for HIV-associated nephropathy

Steven Menez  1 , Mohamad Hanouneh  1 , Blaithin A McMahon  1 , Derek M Fine  1 , Mohamed G Atta  1
Affiliations
Review

Pharmacotherapy and treatment options for HIV-associated nephropathy

Steven Menez et al. Expert Opin Pharmacother. 2018 Jan.

Abstract

Introduction: Human immunodeficiency virus (HIV) remains a worldwide disease with significant mortality and morbidity. There are a multitude of HIV-related kidney diseases including HIV-associated nephropathy (HIVAN) most prominently. The risk of developing HIVAN increases with decreasing CD4 count, higher viral load, and based on genetic factors. The mortality rate for those with HIVAN-end stage renal disease (ESRD) remains 2.5-3 times higher than ESRD patients without HIVAN.

Areas covered: The epidemiology of HIVAN, particularly risk assessment, will be explored in this review. Further, the pathogenesis of HIVAN, from viral-specific renal expression to the role of genetics as well as characteristic renal pathology will be described. Diagnosis and management of HIVAN will be addressed, with an emphasis on various treatment strategies including medication, dialysis, and kidney transplantation.

Expert opinion: HIVAN is associated with a high risk for progression to ESRD and increased mortality. The backbone of HIVAN therapy remains combined anti-retroviral therapy (cART), while adjunctive therapies including RAAS blockade and prednisone, should be considered. In those who progress to ESRD, dialysis remains the mainstay of management, though increasing evidence has demonstrated that kidney transplantation can be effective in those with controlled HIV disease.

Keywords: ESRD; HIV; HIVAN; dialysis; kidney biopsy; transplantation.

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Conflict of interest statement

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Figures

Figure 1:
Figure 1:. Typical renal pathological features of HIVAN
A. Collapsing glomeulopathy with characteristic epithelial proliferation in Bowman’s capsule. B. Tubular cystic dilation Characteristic of HIVAN (photos courtesy of Dr. S. Bagnasco).
Figure 2:
Figure 2:. Diagram of HIVAN Diagnosis and Management:
See this image and copyright information in PMC

References

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