Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
HIV associated nephropathy medical therapy
Introduction
Overview
Overview
The treatment of HIV associated nephropathy (HIVAN) includes: combined antiretroviral therapy (cART), renin–angiotensin–aldosterone system (RAAS) blockade, corticosteroids and renal replacement with dialysis.[1]
Medical Therapy
Medical Therapy
Combined Antiretroviral Therapy (cART)
- Treatment with ART is recommended in all HIV-positive patients regardless of their CD4 count.[1]
- In a retrospective cohort study, patients with HIV associated nephropathy (HIVAN) with cART had a better renal survival compared to patients with no treatment.[2]
- In a cohort study, treatment with cART was associated with reduction in the incidence of HIVAN.[3]
Renin–angiotensin–aldosterone system (RAAS) blockade
- In a study, renal survival was increased in patients treated with captopril compared to non treated controls.[4] Â
- In another study, longer renal survival was reported in patients treated with fosinopril compared to untreated patients.[5]
- Treatment with ACE inhibitor/ARBs in HIV-positive patients is recommended when there is:[6]
- Confirmed or suspected HIVAN
- Significant albuminuria (>30 mg/day in diabetic patients and >300 mg/ day in non-diabetic patients)Â
- ACE inhibitors/ARBs have protective effects in patients with chronic renal disease (CKD) by decreasing proteinuria and the deterioration rate of renal function.[7]
Corticosteroids
- On renal biopsy of patients with HIVAN there is significant tubulointerstitial inflammation, which has been shown to decrease after steroid treatment.[1]
- In a retrospective cohort study, an association was reported between treatment with corticosteroids and the preservation of renal function in HIVAN patients.[8]
- Another retrospective study, reported that corticosteroids delay the progression of HIVAN to renal insufficiency.[9]
Renal replacement with dialysis Â
- All patients with HIVAN that have progressed to end stage renal disease (ESRD) should go through renal replacement with dialysis.[10]
- The rates of HIVAN progressing to ESRD increased between 1989 to 2006, but has declined since then to 2011.[11]
- There is no need to isolate HIV positive patients in the dialysis center unlike in infection with hepatitis B.[10]
- Predictors of poor survival for patients with HIVAN and on dialysis are:[12]
References
References
- ↑ 1.0 1.1 1.2 Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA; et al. (2018). “HIV-associated nephropathy: links, risks and management”. HIV AIDS (Auckl). 10: 73–81. doi:10.2147/HIV.S141978. PMC 5975615. PMID 29872351.
- ↑ Atta MG, Gallant JE, Rahman MH, Nagajothi N, Racusen LC, Scheel PJ; et al. (2006). “Antiretroviral therapy in the treatment of HIV-associated nephropathy”. Nephrol Dial Transplant. 21 (10): 2809–13. doi:10.1093/ndt/gfl337. PMID 16864598.
- ↑ Lucas GM, Eustace JA, Sozio S, Mentari EK, Appiah KA, Moore RD (2004). “Highly active antiretroviral therapy and the incidence of HIV-1-associated nephropathy: a 12-year cohort study”. AIDS. 18 (3): 541–6. doi:10.1097/00002030-200402200-00022. PMID 15090808.
- ↑ Kimmel PL, Mishkin GJ, Umana WO (1996). “Captopril and renal survival in patients with human immunodeficiency virus nephropathy”. Am J Kidney Dis. 28 (2): 202–8. doi:10.1016/s0272-6386(96)90302-9. PMID 8768914.
- ↑ Wei A, Burns GC, Williams BA, Mohammed NB, Visintainer P, Sivak SL (2003). “Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition”. Kidney Int. 64 (4): 1462–71. doi:10.1046/j.1523-1755.2003.00230.x. PMID 12969167.
- ↑ Lucas GM, Ross MJ, Stock PG, Shlipak MG, Wyatt CM, Gupta SK; et al. (2014). “Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America”. Clin Infect Dis. 59 (9): e96–138. doi:10.1093/cid/ciu617. PMC 4271038. PMID 25234519.
- ↑ Sarafidis PA, Khosla N, Bakris GL (2007). “Antihypertensive therapy in the presence of proteinuria”. Am J Kidney Dis. 49 (1): 12–26. doi:10.1053/j.ajkd.2006.10.014. PMID 17185142.
- ↑ Eustace JA, Nuermberger E, Choi M, Scheel PJ, Moore R, Briggs WA (2000). “Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids”. Kidney Int. 58 (3): 1253–60. doi:10.1046/j.1523-1755.2000.00280.x. PMID 10972688.
- ↑ Laradi A, Mallet A, Beaufils H, Allouache M, Martinez F (1998). “HIV-associated nephropathy: outcome and prognosis factors. Groupe d’ Etudes Néphrologiques d’Ile de France”. J Am Soc Nephrol. 9 (12): 2327–35. PMID 9848787.
- ↑ 10.0 10.1 Menez S, Hanouneh M, McMahon BA, Fine DM, Atta MG (2018). “Pharmacotherapy and treatment options for HIV-associated nephropathy”. Expert Opin Pharmacother. 19 (1): 39–48. doi:10.1080/14656566.2017.1416099. PMC 6381591. PMID 29224373.
- ↑ Razzak Chaudhary S, Workeneh BT, Montez-Rath ME, Zolopa AR, Klotman PE, Winkelmayer WC (2015). “Trends in the outcomes of end-stage renal disease secondary to human immunodeficiency virus-associated nephropathy”. Nephrol Dial Transplant. 30 (10): 1734–40. doi:10.1093/ndt/gfv207. PMC 4829059. PMID 26175146.
- ↑ Atta MG, Fine DM, Kirk GD, Mehta SH, Moore RD, Lucas GM (2007). “Survival during renal replacement therapy among African Americans infected with HIV type 1 in urban Baltimore, Maryland”. Clin Infect Dis. 45 (12): 1625–32. doi:10.1086/523728. PMC 4096866. PMID 18190325.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2];Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[3]Krzysztof Wierzbicki M.D. [4]