HIV-1 infection and the kidney: an evolving challenge in HIV medicine.
With the advent of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections has declined substantially, and cardiovascular, liver, and renal diseases have emerged as major causes of morbidity and mortality in individuals with human immunodeficiency virus (HIV). Acute renal failure is common in HIV-infected patients and is associated with acute infection and medication-related nephrotoxicity. HIV-associated nephropathy is the most common cause of chronic kidney disease in HIV-positive African American populations and may respond to HAART. Other important HIV-associated renal diseases include HIV immune complex kidney diseases and thrombotic microangiopathy. The increasing importance of non-HIV-associated diseases, such as diabetes mellitus, hypertension, and vascular disease, to the burden of chronic kidney disease has been recognized, focusing attention on prevention and control of these diseases in HIV-positive individuals. HIV-positive individuals who experience progression to end-stage renal disease and who have undetectable HIV-1 viral loads while receiving HAART should be evaluated for renal transplant. Emerging evidence suggests that HIV-positive individuals may have graft and patient survival comparable to HIV-negative individuals. Several studies suggest that HIV-1 can potentially infect renal cells, and HIV transgenic mice have clarified the roles of a number of HIV proteins in the pathogenesis of HIV-associated renal disease. Host factors may modify disease expression at the level of cytokine networks and the renal microvasculature and contribute to the pathogenic effects of HIV-1 infection on the kidney.
de Silva
Thushan I
TI
Section of Infection, Inflammation and Immunity, University of Sheffield School of Medicine and Biomedical Sciences, L Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
Post
Frank A
FA
Griffin
Matthew D
MD
Dockrell
David H
DH
D016263:AIDS-Associated Nephropathy / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology; D000208:Acute Disease; D058186:Acute Kidney Injury / Q000453:epidemiology; D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001741:Black or African American / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors; D000818:Animals; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D015658:HIV Infections / Q000453:epidemiology* / Q000503:physiopathology; D015497:HIV-1; D006801:Humans; D007668:Kidney / Q000098:blood supply; D007674:Kidney Diseases / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016030:Kidney Transplantation; D051379:Mice; D008822:Mice, Transgenic; D008833:Microcirculation; D063065:Organophosphonates / Q000627:therapeutic use; D000068698:Tenofovir; D014764:Viral Proteins