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J Am Soc Nephrol. 2017 Nov;28(11):3142-3154. doi: 10.1681/ASN.2017040468. Epub 2017 Aug 7.

Kidney Disease in HIV: Moving beyond HIV-Associated Nephropathy.

Author information

1
Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California.
2
Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California; and.
3
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
4
Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California; michelle.estrella@ucsf.edu.

Abstract

In developed countries, remarkable advances in antiretroviral therapy have transformed HIV infection into a chronic condition. As a result, HIV-associated nephropathy, the classic HIV-driven kidney lesion among individuals of African descent, has largely disappeared in these regions. However, HIV-positive blacks continue to have much higher rates of ESRD than HIV-positive whites, which could be attributed to the APOL1 renal risk variants. Additionally, HIV-positive individuals face adverse consequences beyond HIV itself, including traditional risk factors for CKD and nephrotoxic effects of antiretroviral therapy. Concerns for nephrotoxicity also extend to HIV-negative individuals using tenofovir disoproxil fumarate-based pre-exposure prophylaxis for the prevention of HIV infection. Therefore, CKD remains an important comorbid condition in the HIV-positive population and an emerging concern among HIV-negative persons receiving pre-exposure prophylaxis. With the improved longevity of HIV-positive individuals, a kidney transplant has become a viable option for many who have progressed to ESRD. Herein, we review the growing knowledge regarding the APOL1 renal risk variants in the context of HIV infection, antiretroviral therapy-related nephrotoxicity, and developments in kidney transplantation among HIV-positive individuals.

KEYWORDS:

Apolipoprotein L1; HIV nephropathy; chronic kidney disease

PMID:
28784698
PMCID:
PMC5661296
[Available on 2018-11-01]
DOI:
10.1681/ASN.2017040468
[Indexed for MEDLINE]

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