Epidemiology, clinical characteristics, and management of chronic kidney disease in human immunodeficiency virus-infected patients

Abstract

Antiretroviral therapy has markedly reduced acquired immune deficiency syndrome-related deaths and opportunistic infectious diseases. This has resulted in prolonged survival of individuals infected with the human immunodeficiency virus (HIV). However, this improvement in survival has been accompanied by an increase in the incidence of chronic kidney disease (CKD) and end-stage renal disease. CKD is now epidemic among HIV-infected populations in both Western and Eastern countries. Risk factors associated with CKD in HIV-infected populations include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, a low CD4 cell count, and a high HIV viral load. Clinical experience has shown that HIV-infected individuals often have one or more concurrent risk factors for CKD. The cumulative effect of multiple risk factors on the development of CKD should be noted in this population. Glomerular disease directly related to HIV infection, so-called HIV-associated nephropathy, remains an important cause of CKD among a limited HIV population of African descent, but is less likely to be common among other urban HIV populations. The impact of exposure to nephrotoxic antiretroviral agents on the development of kidney disease is both an old and a new concern. In particular, the association of tenofovir with kidney tubular injury has been an area of great interest. The findings regarding tenofovir’s adverse effect on long-term kidney function vary among studies. The early identification and treatment of CKD is recommended for reducing the burden of patients requiring dialysis in HIV-infected populations. Periodic monitoring of urinary concentrations of albumin, protein, and tubular injury markers such as low-molecular-weight proteins may be useful for the early diagnosis of patients at risk for incident CKD. This review focuses on recent epidemiology, clinical characteristics, and management of CKD in a contemporary HIV-infected population.

Keywords: Antiretroviral therapy, Tenofovir, Human immunodeficiency virus-associated nephropathy, Albuminuria, Renal tubular biomarkers, Cystatin C, Diabetes mellitus, Hypertension

Core tip: Kidneys are affected by the human immunode-

ficiency virus (HIV) and its associated therapies. As HIV subjects now have longevity while they receive combination anti-retroviral therapy (cART), kidney disease has been prominent among the current HIV subjects on cART. HIV subjects often have several coexisting risk factors of kidney disease, including diabetes and hypertension. Measurements of albuminuria, proteinuria, urinary low-molecular weight proteins, and serum cystatin C are necessary for early detection of kidney disease. Collaborative discussions between HIV experts and nephrologists are warranted to achieve the good treatment of chronic kidney disease in HIV patients.