HIV associated nephropathy natural history, complications and prognosis

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]

Overview

HIV-associated nephropathy (HIVAN) will progress to end stage renal disease (ESRD) in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome.

Natural History

If left untreated, HIV-associated nephropathy (HIVAN) will progress to end stage renal disease (ESRD) in a few weeks to months.^[1]
Treatment with cART has shown 60% reduction in the developement of HIVAN.^[1]
Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.^[1]
Early diagnosis and Immediate treatment has shown better outcome.^[1]

Complications

Possible complications that are associated with HIV-associated nephropathy include:

End stage renal disease (ESRD) ^[1]

Prognosis

Before the advent of cART therapy, the prognosis of HIV-associated nephropathy was fatal. The mortality rate during this time was 100% within 6 months.^[1]
Today, the prognosis of HIVAN with the availability of cART therapy still remains grim,^[1] however, treatment with cART has increased renal survival rate.^[2]
Early diagnosis and Immediate treatment has shown better outcome.^[1]
Treatment with cART has shown 60% reduction in the developement of HIVAN.^[1]
Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.^[1]
The current first and second year survival rate of HIV-associated nephropathy is estimated to be around 63% and 43% respectively, with the use of HAART therapy.^[3]
Several factors have been associated with increased risk of progression of kidney disease in patients with HIVAN, which include:^[4]
- Low CD4 count
- High viral load
- Proteinuria (high-grade)
- APOL1 polymorphism
- Comorbidities (hypertension and diabetes)

References

↑ ^1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 Atta MG, Lucas GM, Fine DM (2008). “HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management”. Expert Rev Anti Infect Ther. 6 (3): 365–71. doi:10.1586/14787210.6.3.365. PMID 18588500.
↑ 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.
↑ Atta MG, Choi MJ, Longenecker JC, Haymart M, Wu J, Nagajothi N; et al. (2005). “Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy”. Am J Med. 118 (11): 1288. doi:10.1016/j.amjmed.2005.05.027. PMID 16271919.
↑ 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.

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[pmid18588500-1] 1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 Atta MG, Lucas GM, Fine DM (2008). “HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management”. Expert Rev Anti Infect Ther. 6 (3): 365–71. doi:10.1586/14787210.6.3.365. PMID 18588500.

[pmid18190325-2] 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.

[pmid16271919-3] Atta MG, Choi MJ, Longenecker JC, Haymart M, Wu J, Nagajothi N; et al. (2005). “Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy”. Am J Med. 118 (11): 1288. doi:10.1016/j.amjmed.2005.05.027. PMID 16271919.

[pmid29872351-4] 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.

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