HIV related renal disease in Africans

Abstract

Renal disease is becoming an increasingly prevalent entity in human immunodefi ciency virus (HIV)–infected patients, first diagnosed in AIDS patients in 1984. The HIV-related renal disease represents a spectrum of clinical and histological conditions presenting as acute renal failure, chronic renal failure, glomerulopathies, i.e., HIV-associated nephropathy (HIVAN), immune mediated glomerulopathies, and thrombotic microangiopathies with a sudden onset of symptoms and rapid development of end-stage kidney disease (ESRD). HIVAN can be caused directly or indirectly by HIV and/or by drug-related ARVs effects that are directly nephrotoxic, or lead to changes in renal function by inducing metabolic vaculopathy and renal damage. HIV-associated glomerulosclerosis mostly affects black individuals. The increase in life expectancy and alteration of lipid metabolism due to receipt of highly active antiretroviral therapy (HAART), angiotensin converting enzyme (ACE) inhibitors, and prednisolone are expected to result in an increased prevalence of diabetes and hypertension and, thus, to secondary diabetic and hypertensive renal damage. The recommended renal replacement therapy for HIV-associated end stage renal disease includes chronic intermittent dialysis, chronic peritoneal dialysis, or renal transplantation in carefully selected patients.
This article reviews, the current knowledge about HIV-associated renal disease, related nephropathies, the history of HIVAN focusing on advances in the understanding of pathogenesis, epidemiology, toxic drug effects of combination antiretroviral pharmacotherapy, and treatment. Future research is needed into the earlier detection and treatment of these diseases, which have a high mortality.