Causes

In the general population, diabetes and hypertension are the major causes of chronic kidney disease. Problems with kidney function in HIV-infected people may be due to medications or HIV itself. HIV-associated nephropathy (HIVAN) is highly prevalent among HIV-positive people in Africa, with recent studies showing rates of between 25 and 50% in Kenya and Uganda.1 2 However, HIVAN is usually reversed after intiation of antiretroviral therapy.3 4

Although some antiretroviral drugs can be kidney-toxic, antiretroviral therapy has generally been observed to reverse or slow the progression of kidney disease. The nucleotide reverse transcriptase inhibitor tenofovir (Viread) has been identified as one cause of renal toxicity, although recent studies have called this into question. See Tenofovir and Side-effects - Kidney toxicity for further details.

Indinavir (Crixivan) is also a known cause of kidney toxicity, while one report has identified the development of kidney stones in 4% of patients taking ritonavir-boosted lopinavir (Kaletra).5 See Indinavir and Lopinavir for further details.

Kidney disease in HIV-infected people has been associated with more advanced HIV disease, low CD4 cell counts, and diabetes. A study of 35 people with nephropathy without hypertension or diabetes found that kidney disease was linked to cidofovir (Vistide), indinavir or cotrimoxazole (Septrin / Bactrim) therapy, systemic chemotherapy for lymphoma, acute bacterial infection of the kidneys and sepsis.6

The Women's Interagency HIV Study (WIHS) found higher mortality rates in women who had poor kidney function at the time of starting antiretroviral therapy, particularly at more advanced stages of HIV disease.7

A data review of HIV-positive US veterans found slightly higher rates of chronic kidney disease (14% vs. 11%) in those co-infected with HCV.8 Smoking for over ten years, and African or Haitan race, have also been identified as risk factors for the development of kidney disease in HIV-positive patients.9

References

  1. Muloma E et al. Renal disease in antiretroviral naive HIV-infected population in western Kenya. Third International AIDS Society Conference on HIV Pathogenesis and Treatment, Rio de Janeiro, abstract MoPe11, 2005
  2. Pepper L et al. Prevalence of renal disease in patients attending the HIV/AIDS clinic at Mbarara University Teaching Hospital. Third International AIDS Society Conference on HIV Pathogenesis and Treatment, Rio de Janeiro, abstract TuPe15, 2005
  3. Scheurer D et al. Rapid reversal of renal failure after initiation of HAART: a case report. AIDS Read 14: 443-447, 2004
  4. Szczech LA et al. The clinical epidemiology and course of the spectrum of renal diseases associated with HIV infection. Kidney Int 66: 1145-1152, 2004
  5. Thanh DC et al. Lopinavir-ritonavir (Kaletra) and lithiasis: seven cases. AIDS 18: 705-706, 2004
  6. Visnegarwala F et al. Prevalence of renal disease in an inner city HIV-infected cohort. Second International AIDS Society Conference on HIV Pathogenesis and Treatment, Paris (Antiviral Therapy 8:1), abstract 1147, 2003
  7. Estrella MM et al. The impact of kidney function at highly active antiretroviral therapy initiation on mortality in HIV-infected women. J Acquir Immune Defic Syndr, advance online publication, 2010
  8. Fischer MJ et al. Hepatitis C and the risk of kidney disease and mortality in veterans with HIV. J Acquir Immune Defic Syndr 53: 222-26, 2010
  9. Miguez-Burbano MJ et al. Renal disease in HIV infected subjects: the deleterious effect of smoking. Fifteenth International AIDS Conference, Bangkok, abstract MoPeB3274, 2004
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