title: HIV-associated nephropathies: epidemiology, pathology, mechanisms and treatment.
abstract: HIV is a highly adaptive, rapidly evolving virus, which is associated with renal diseases including collapsing glomerulopathy-the classic histomorphological form of HIV-associated nephropathy. Other nephropathies related to viral factors include HIV-immune-complex kidney disease and thrombotic microangiopathy. The distribution of HIV-associated kidney diseases has changed over time and continues to vary across geographic regions worldwide. The reasons for this diversity are complex and include a critical role of APOL1 variants and possibly other genetic factors, disparities in access to effective antiviral therapies, and likely other factors that we do not yet fully understand. The mechanisms responsible for HIVAN, including HIV infection of podocytes and tubular epithelial cells, the molecules responsible for HIV entry, and diverse mechanisms of cell injury, have been the focus of much study. Although combined antiretroviral therapy is effective at preventing and reversing HIVAN, focal segmental glomerulosclerosis, arterionephrosclerosis and diabetic nephropathy are increasingly common in individuals who have received such therapy for many years. These diseases are associated with metabolic syndrome, obesity and premature ageing. Future directions for HIV-related kidney disease will involve regular screening for drug nephrotoxicity and incipient renal disease, as well as further research into the mechanisms by which chronic inflammation can lead to glomerular disease.
authors: Department of Pathology, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Baltimore, MD 21287, USA.
authors: Avi Z
authors: AZ
authors: Rosenberg
authors: School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa.
authors: Saraladevi
authors: S
authors: Naicker
authors: Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD 21702, USA.
authors: Cheryl A
authors: CA
authors: Winkler
authors: Kidney Disease Section, NIDDK, NIH, 10 Center Drive, 3N116 Bethesda, MD 20892-1268, USA.
authors: Jeffrey B
authors: JB
authors: Kopp
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy; D006801:Humans