Interventions for HIV-associated nephropathy.
BACKGROUND
Human immunodeficiency virus associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in Human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretrovirals, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated.


OBJECTIVE
To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality.


METHODS
We searched The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's specialised register, MEDLINE, EMBASE, AIDSearch, reference lists of articles and conference proceedings without language restrictions. We searched the international clinical trials registry platform search portal and also contacted individual researchers, research organisations and pharmaceutical companies that manufacture the drugs used for interventions.


METHODS
Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN.


METHODS
We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. We applied the inclusion criteria to identify four relevant ongoing studies, one is ongoing while the remaining two have completed recruitment and are yet to be published. The fourth study was suspended for an unknown reason.


RESULTS
No completed RCTs or quasi-RCTs were identified to be included in the study.


CONCLUSIONS
There is no RCT-based evidence upon which to base guidelines for the treatment of HIVAN. However, steroids and ACEI appear to improve the kidney function of patients in the observational studies that were identified. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.
Yahaya
Ismail
I
a) WMHTAC, Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK, b) Save The Youth Initiative, PO Box 3951, Kaduna North, Kaduna, Nigeria.
Uthman
Abdulrahman Olalekan
AO
Uthman
Muhammed Mubashir B
MM
D016263:AIDS-Associated Nephropathy / Q000628:therapy*; D006801:Humans