Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 May 25:10:73-81.
doi: 10.2147/HIV.S141978. eCollection 2018.

HIV-associated nephropathy: links, risks and management

Laura Palau #  1 , Steven Menez #  1 , Javier Rodriguez-Sanchez  1 , Tessa Novick  1 , Marco Delsante  2 , Blaithin A McMahon  1 , Mohamed G Atta  1
Affiliations
Review

HIV-associated nephropathy: links, risks and management

Laura Palau et al. HIV AIDS (Auckl). .

Abstract

Despite the decreased incidence of human immunodeficiency virus (HIV)-associated nephropathy due to the widespread use of combined active antiretroviral therapy, it remains one of the leading causes of end-stage renal disease (ESRD) in HIV-1 seropositive patients. Patients usually present with low CD4 count, high viral load and heavy proteinuria, with the pathologic findings of collapsing focal segmental glomerulosclerosis. Increased susceptibility exists in individuals with African descent, largely due to polymorphism in APOL1 gene. Other clinical risk factors include high viral load and low CD4 count. Advanced kidney disease and nephrotic range proteinuria have been associated with progression to ESRD. Improvement in kidney function has been observed after initiation of combined active antiretroviral therapy. Other treatment options, when clinically indicated, are inhibition of the renin-angiotensin system and corticosteroids. Further routine management approaches for patients with chronic kidney disease should be implemented. In patients with progression to ESRD, kidney transplant should be pursued, provided that viral load control is adequate. Screening for the presence of kidney disease upon detection of HIV-1 seropositivity in high-risk populations is recommended.

Keywords: APOL1 polymorphism; ESRD; HIV; HIVAN; kidney transplant.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
HIV-associated nephropathy. Notes: (A) Collapsing glomerulopathy. The glomerular tuft is collapsed and marked podocyte hypertrophy is observed. Podocytes show marked protein overload. Light microscopy, silver-stained section, 200× magnification. (B) Diffuse podocyte injury with complete foot process effacement and focal microvillous transformation. A tubuloreticular inclusion is observed in an endothelial cell (box). Scanning electron microscopy, 6000× magnification.
Figure 2
Figure 2
Spectrum of APOL1-associated kidney diseases. Abbreviations: ESRD, end-stage renal disease; FSGS, focal segmental glomerulosclerosis; HIVAN, human immunodeficiency virus-associated nephropathy.
See this image and copyright information in PMC

References

    1. Mocroft A, Reiss P, Gasiorowski J, et al. Serious fatal and nonfatal non-AIDS-defining illnesses in Europe. J Acquir Immune Defic Syndr. 2010;55(2):262–270. - PubMed
    1. Waheed S, Atta MG. Predictors of HIV-associated nephropathy. Expert Rev Anti Infect Ther. 2014;12(5):555–563. - PubMed
    1. Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKD atlas of renal pathology: HIV-associated nephropathy (HIVAN) Am J Kidney Dis. 2016;68(2):e13–e14. - PubMed
    1. Swanepoel CR, Atta MG, D’Agati VD, et al. Kidney disease in the setting of HIV infection: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference. Kidney Int. 2018;93(3):545–559. - PMC - PubMed
    1. Ahuja TS, Borucki M, Funtanilla M, Shahinian V, Hollander M, Rajaraman S. Is the prevalence of HIV-associated nephropathy decreasing? Am J Nephrol. 1999;19(6):655–659. - PubMed