Pharmacotherapy for human immunodeficiency virus-associated nephropathy.
Approximately 10% of adult patients with human immunodeficiency virus (HIV) infection have HIV-associated nephropathy (HIVAN). This condition, a leading cause of renal failure, is characterized by damage to specific areas of the renal filtration system. It manifests with increased serum creatinine levels, overt proteinuria, and in some patients, end-stage renal disease (ESRD). The mortality rate for HIVAN-related ESRD is high-30% within the first year of onset. Most instances of HIVAN occur in patients of African descent. Although advances in defining the pathology have been made, the optimal treatment strategy remains unclear. Potential benefits of potent combination antiretroviral therapy, angiotensin-converting enzyme (ACE) inhibitors, and corticosteroids have been reported in small clinical trials and case reports. Cyclosporine is another option, but clinical experience with this agent in managing HIVAN is limited. Few conclusions can be drawn from the limited body of available evidence. Antiretroviral therapy, ACE inhibitors, and corticosteroids are possibly associated with reversal of serum creatinine level increases and proteinuria, but studies are necessary to further define the role of these agents in therapy. Close monitoring is advised when treating any patient with HIVAN.
Pope
Scott D
SD
Department of Pharmacy, Carolinas Medical Center, Carolinas HealthCare System, Charlotte, NC 28203, and the Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA. scott.pope@carolinas.org
Johnson
Melissa D
MD
May
D Byron
DB
D016263:AIDS-Associated Nephropathy / Q000188:drug therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans
D000806:Angiotensin-Converting Enzyme Inhibitors; D044966:Anti-Retroviral Agents; D005938:Glucocorticoids; D016572:Cyclosporine