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Review
. 2021 Jan;22(1):69-82.
doi: 10.1080/14656566.2020.1817383. Epub 2020 Sep 21.

Pharmacotherapeutic options for kidney disease in HIV positive patients

Anam Tariq  1 , Hannah Kim  2 , Hashim Abbas  1 , Gregory M Lucas  3 , Mohamed G Atta  1
Affiliations
Review

Pharmacotherapeutic options for kidney disease in HIV positive patients

Anam Tariq et al. Expert Opin Pharmacother. 2021 Jan.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Expert Opin Pharmacother. 2022 Apr;23(6):i. doi: 10.1080/14656566.2022.2058762. Epub 2022 Mar 28. Expert Opin Pharmacother. 2022. PMID: 35345944 No abstract available.

Abstract

Introduction: Since the developmentof combined antiretroviral therapy (cART), HIV-associated mortality and the incidence of HIV-associated end-stage kidney disease (ESKD) has decreased. However, in the United States, an increase in non-HIV-associated kidney diseases within the HIV-positive population is expected.

Areas covered: In this review, the authors highlight the risk factors for kidney disease within an HIV-positive population and provide the current recommendations for risk stratification and for the monitoring of its progression to chronic kidney disease (CKD), as well as, treatment. The article is based on literature searches using PubMed, Medline and SCOPUS.

Expert opinion: The authors recommend clinicians (1) be aware of early cART initiation to prevent and treat HIV-associated kidney diseases, (2) be aware of cART side effects and discriminate those that may become more nephrotoxic than others and require dose-adjustment in the setting of eGFR ≤ 30ml/min/1.73m2, (3) follow KDIGO guidelines regarding screening and monitoring for CKD with a multidisciplinary team of health professionals, (4) manage other co-infections and comorbidities, (5) consider changing cART if drug induced toxicity is established with apparent eGFR decline of ≥ 10ml/min/1.73m2 or rising creatinine (≥0.5mg/dl) during drug-drug interactions, and (6) strongly consider kidney transplant in appropriately selected individuals with end stage kidney failure.

Keywords: APOL1; HIV; HIVAN; HIVICK; antiretroviral medications; dialysis; nephrotoxicity.

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Conflict of interest statement

Declaration of Interest:

The authors have no other 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 apart from those disclosed.

Figures

Figure 1.
Figure 1.
A. LM 400X, silver stain. Glomerular capillary with collapsed basement membrane and glomerular tuft with podocyte hypertrophy and hyperplasia, and microcystic dilatation of tubules. B. LM, PAS. Excessing protein deposition and tubular cystic dilatation. C & D. EM. Extensive podocyte foot effacement and frequent tubuloreticular inclusions in endothelial cells. Podocyte effacement is present.
Figure 2.
Figure 2.
A. LM at 400X, H&E stain. Severe mesangial proliferation. B. LM at 400X, silver stain. Glomerulus with severe mesangial proliferation and collapsing glomerulopathy. C. & D. EM. Diffuse podocyte effacements, depositions in basement membranes.
Figure 3.
Figure 3.
EM. Tenofovir alafenainide fumarate (TAF) induced mitochondrial toxicity in proximal tubule.
See this image and copyright information in PMC

References

    1. UNAIDS Data. UNAIDS. 2019. https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_...
    1. Dadonaite B Antiretroviral therapy has saved millions of lives from AIDS and could save more. 2019.
    1. Razzak Chaudhary S, Workeneh BT, Montez-Rath ME, Zolopa AR, Klotman PE, Winkelmayer WC. Trends in the outcomes of end-stage renal disease secondary to human immunodeficiency virus-associated nephropathy. Nephrol Dial Transplant. 2015;30(10):1734–40. - PMC - PubMed

    2. - This paper offers data and insights on HIV prevalence in US patients with ESKD.

    1. Wyatt CM, Klotman PE. HIV-1 and HIV-Associated Nephropathy 25 Years Later. Clin J Am Soc Nephrol. 2007;2 Suppl 1:S20–4. - PubMed
    1. Diana NE, Naicker S. Update on current management of chronic kidney disease in patients with HIV infection. Int J Nephrol Renovasc Dis. 2016;9:223–34. - PMC - PubMed

    2. - This is a comprehensive understanding and management of HIV infection among those with chronic kidney disease.

MeSH terms