Treatment

Treatments for kidney impairment depend in part on the cause of the condition. There is not enough evidence to provide a general indication of how best to treat HIV-positive patients with renal disease. Treatments must therefore be tailored to the individual patient's needs and circumstances.

If impairment is severe, antiretrovirals such as tenofovir may be stopped. However, the use of antiretrovirals can improve kidney function by improving general health and removing the damaging effects of co-infections such as fungal infections and their treatments.1 2 The doses of all nucleoside and nucleotide reverse transcriptase inhibitors, with the exception of abacavir, need to be reduced in patients with kidney disease.

Treatment may also be provided to boost phosphorous levels, reduce blood pressure and increase hydration.

In cases of severe or 'end-stage' kidney disease, dialysis may be a viable option for HIV-positive patients. This involves filtration of the blood by a dialysis machine, which takes over the function of the kidneys. Transplantation is also an option for HIV-positive patients now that antiretroviral therapy has reduced the risks associated with immunosuppression to prevent rejection of the transplant and the risk of death from HIV itself. A cross-sectional analysis of the EuroSIDA cohort found end-stage kidney disease among only 0.46% of European patients with HIV, mostly young black men.3 HIV-positive patients with end-stage kidney disease have safely received kidney transplants from both HIV-negative and HIV-positive donors. [ref]

References

  1. Reisler R et al. Chronic kidney disease and the use of HAART. Twelfth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 818, 2005
  2. Siwani R et al. Complete suppression of HIV viral replication may improve renal outcome in patients with HIV-associated nephropathy (HIVAN). Third International AIDS Society Conference on HIV Pathogenesis and Treatment, Rio de Janeiro, abstract TuPe7, 2005
  3. Trullas JC et al. Dialysis and renal transplantation in HIV-infected patients: a European study. J Acquir Immune Defic Syndr, online publication, August 31, 2010, 2010
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