Recent change in spectrum of HIV-linked kidney disease
Scott D. Cohen, M.D., M.P.H., from George Washington University in Washington, D.C., and colleagues discussed the spectrum of HIV-associated renal diseases, including diseases that are directly linked with infection and those that are linked to HIV treatment.
The researchers note that over the last three decades, antiretroviral treatment has transformed HIV to a chronic illness, with associated changes in the incidence, type, and severity of kidney diseases. There has been an increase in evidence of nephrotoxic effects of antiretroviral therapy and the prevalence of kidney diseases resulting from aberrant metabolism and aging. HIV-associated nephropathy has decreased in frequency and is now known to arise from interactions among the virus, host genotype, host response, and effective treatment. The subgroup of HIV-infected patients with immune-complex renal disease is increasingly being recognized, and the prevalence of this type of disease may be increasing as a result of successful HIV therapy. For patients with HIV in whom end-stage renal disease develops, kidney transplantation holds promise to increase the quantity and quality of life.
"Additional research, including well-designed randomized, controlled trials, is needed to determine effective therapeutic approaches to treating the diverse renal manifestations of HIV infection and improve the outcomes of treatment," the authors write.
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