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Review
. 2022 Oct 24;3(1):1-11.
doi: 10.1159/000526868. eCollection 2023 Jan-Dec.

HIV-Associated Nephropathy in 2022

Frederick Berro Rivera  1 , Marie Francesca Mapua Ansay  2 , Jem Marie Golbin  3 , Pia Gabrielle I Alfonso  3 , Gerard Francis E Mangubat  4 , Rajiv Hans Solita Menghrajani  5 , Siena Placino  5 , Marianne Katharina Vicera Taliño  2 , Deogracias Villa De Luna  6 , Nicolo Cabrera  7 , Carlo Nemesio Trinidad  8 , Amir Kazory  9
Affiliations
Review

HIV-Associated Nephropathy in 2022

Frederick Berro Rivera et al. Glomerular Dis. .

Abstract

Background: HIV-associated nephropathy (HIVAN) is a renal parenchymal disease that occurs exclusively in people living with HIV. It is a serious kidney condition that may possibly lead to end-stage kidney disease, particularly in the HIV-1 seropositive patients.

Summary: The African-American population has increased susceptibility to this comorbidity due to a strong association found in the APOL1 gene, specifically two missense mutations in the G1 allele and a frameshift deletion in the G2 allele, although a "second-hit" event is postulated to have a role in the development of HIVAN. HIVAN presents with proteinuria, particularly in the nephrotic range, as with other kidney diseases. The diagnosis requires biopsy and typically presents with collapsing subtype focal segmental glomerulosclerosis and microcyst formation in the tubulointerstitial region. Gaps still exist in the definitive treatment of HIVAN - concurrent use of antiretroviral therapy and adjunctive management with like renal-angiotensin-aldosterone system inhibitors, steroids, or renal replacement therapy showed benefits.

Key message: This study reviews the current understanding of HIVAN including its epidemiology, mechanism of disease, related genetic factors, clinical profile, and pathophysiologic effects of management options for patients.

Keywords: Chronic kidney disease; Glomerular disease; Glomerulonephritis; HIV-associated nephropathy; Pathology.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Mechanism of APOL1 upregulation by the human immunodeficiency virus.
Fig. 2
Fig. 2
Pathophysiology of HIVAN.
See this image and copyright information in PMC

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