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Immunologic Biomarkers, Morbidity, and Mortality in Treated HIV Infection

Rosuvastatin slows progression of subclinical atherosclerosis in patients with treated HIV infection

Antiretroviral therapy for the prevention of HIV-1 transmission

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy

Review of the Efficacy, Safety, and Pharmacokinetics of Raltegravir in Pregnancy

Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals

Rosuvastatin Is Effective to Decrease CD8 T-Cell Activation Only in HIV-Infected Patients With High Residual T-Cell Activation Under Antiretroviral Therapy

Botswana's progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: a population-based survey

Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial

Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers

Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013

Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis

Outcomes of HIV-associated Hodgkin lymphoma in the era of antiretroviral therapy

CD4+ and CD8+ T-cell kinetics in aviremic HIV-infected patients developing Hodgkin or non-Hodgkin lymphoma

CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection

Human Immunodeficiency Virus Infection Does Not Worsen Prognosis of Liver Transplantation for Hepatocellular Carcinoma

Ongoing HIV Replication Replenishes Viral Reservoirs During Therapy

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men

Transient elastography for the detection of hepatic fibrosis in HIV-monoinfected adults with elevated aminotransferases on antiretroviral therapy

Association of immune-activation and senescence markers with non-AIDS-defining comorbidities in HIV-suppressed patients

Effects of randomized rosuvastatin compared with placebo on bone and body composition among HIV-infected adults

Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy

Cancer Risk and Use of Protease Inhibitor or Nonnucleoside Reverse Transcriptase Inhibitor–Based Combination Antiretroviral Therapy The D:A:D Study

Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study



The effect of cumulating exposure to abacavir on the risk of cardiovascular disease events in patients from the Swiss HIV Cohort Study

Course and Clinical Significance of CD8+ T-Cell Counts in a Large Cohort of HIV-Infected Individuals

Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients

HIV-1 subtype B-infected MSM may have driven the spread of transmitted resistant strains in France in 2007-12: impact on susceptibility to first-line strategies

Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals

Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study

CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: an observational cohort study

Baseline HIV-1 resistance, virological outcomes, and emergent resistance in the SECOND-LINE trial: an exploratory analysis

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Low Bone Mineral Density in Patients With Well-Suppressed HIV Infection: Association With Body Weight, Smoking, and Prior Advanced HIV Disease

Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial

Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1

Kidney Diseases Associated with Human Immunodeficiency Virus Infection
Published by Anton POZNAK

Updated: 15 February, 2018

Cohen SD, et al. N Engl J Med. 2017 Dec 14;377(24):2363-2374

Highly active ART has led to dramatic improvement in the life expectancy of persons with HIV infection.

Approximately 36.7 million people live with HIV infection worldwide, and there were approximately 2.1 million cases of incident HIV infection globally in 2015. Almost three quarters of HIV-infected persons live in sub-Saharan Africa. Although 18.2 million people worldwide were receiving ART by 2016, only 40% of HIV-infected persons in sub-Saharan Africa received ART as of 2014. The prevalence of HIV infection is much lower in the USA than in sub-Saharan Africa. Approximately 1.2 million persons in the USA have HIV infection, and the annual incidence has been stable at approximately 50,000 infections over the past decade.

Kidney disease, which is a common complication of HIV infection and its treatment, may shorten the lifespan of patients. Soon after the index cases of the AIDS were identified in 1980, various kidney diseases associated with AIDS were recognized. The spectrum of HIV-associated renal diseases includes diseases that are directly associated with infection, those that are linked to the systemic immune response to infection, those that develop as a consequence of superinfections, and those that are associated with the treatment of HIV infection (Table 1). Since the introduction of molecular tools to detect HIV within tissues, our understanding of the pathogenesis of common kidney diseases, such as focal segmental glomerulosclerosis and immune complex renal disease, in persons with HIV infection has improved.

Over the past two decades, antiretroviral therapy has converted HIV infection to a chronic illness, with associated changes in the incidence, type, and severity of HIV-associated kidney diseases. Current antiretroviral therapy regimens suppress viral replication, but this treatment may result in chronic inflammation, premature aging, and metabolic disorders (e.g., diabetes, hyperlipidemia, and abnormal body fat composition) - conditions that are associated with chronic kidney disease.

Table 1. Kidney Diseases in Patients with Human Immunodeficiency Virus Infection

Acute kidney injury Chronic kidney disease Opportunistic infections of the kidney parenchyma Infiltrative lesions of the kidney
Prerenal azotemia
Acute tubular necrosis
ART-associated acute kidney injury
TI nephritis (IRIS)
HIV immune-complex kidney disease (Ig A nephropathy, postinfectious GN, mesangial proliferative GN, lupus-like GN, membranoproliferative GN, cryoglobulinemic GN, Other)
Thrombotic microangiopathies
Urinary tract obstruction (bladder outlet obstruction, ureteral obstruction : fungus balls, blood clots, retroperitoneal fibrosis, lymphadenopathy)
HIV immune-complex kidney disease
ART-associated chronic kidney disease (TI nephritis, crystal nephropathy, TDF-induced nephrotoxicity)
TI renal disease (diffuse infiltrative lymphocytosis syndrome)
Viral (CMV, HSV, Parvovirus, Other)
Mycobacterial, typical and atypical
Bacterial pyelonephritis
Kaposi's sarcoma

HIVAN : HIV-associated nephropathy ; GN : glomerulonephritis ; TI : tubulointerstitial

Table 2. Approaches to Evaluating Kidney Disease in Patients with HIV Infection

Pre-renal   Volume depletion
Bland urine sediment
Fractional excretion of Na < 1%
Intrinsic renal Acute tubular necrosis (sepsis, medications, pigment) Granular or muddy brown casts
Fractional excretion of Na > 2%
Thrombotic microangiopathy Microangiopathic hemolytic anemia
Acute interstitial nephritis (sepsis, medications) Active urine sediment
White-cell casts
HIV-associated immune-complex disease Active urine sediment
Microscopic hematuria
Red-cell casts Hypocomplementemia
Screen for hepatitis and other infections
HIVAN Nephrotic-range proteinuria
HIV viral load
Low CD4 count
cART nephropathy (insterstitial nephritis, crystalluria, mitochondrial toxicity, Fanconi's syndrome) Subnephrotic proteinuria
Controlled viral load and CD4 count
Other kidney syndromes Diabetes
Focal segmental glomerulosclerosis
Post-renal   Obstruction