HIV-associated nephropathy (HIVAN)
- Christina M Wyatt, MD
Christina M Wyatt, MD
- Associate Professor
- Icahn School of Medicine at Mount Sinai
- Paul E Klotman, MD
Paul E Klotman, MD
- President and CEO
- Baylor College of Medicine
HIV infection has been associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). (See "Overview of kidney disease in HIV-positive patients".)
HIV-associated nephropathy (HIVAN), the classic kidney disease associated with HIV infection, was first described in 1984 as a complication of AIDS [1-3], although HIVAN may also occur in patients with less advanced HIV infection or acute seroconversion [4,5]. Histologically, HIVAN is a collapsing form of focal sclerosing glomerulosclerosis (FSGS) (picture 1), accompanied by microcystic tubular dilatation and interstitial inflammation .
Issues related to HIVAN will be discussed in this topic. An overview of kidney disease in patients with HIV infection and discussions of electrolyte abnormalities, dialysis, and transplantation in HIV-positive patients are provided elsewhere. (See "Overview of kidney disease in HIV-positive patients" and "Electrolyte disturbances with HIV infection" and "Human immunodeficiency virus and dialysis" and "Solid organ transplantation in HIV-infected individuals".)
The pathogenesis of HIV-associated nephropathy (HIVAN) is hypothesized to involve several factors:
●Infection of kidney epithelial cells by HIV and expression of HIV genes within infected kidney cells
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- CLINICAL MANIFESTATIONS
- Differential diagnosis
- TREATMENT AND FOLLOW-UP
- Overview of medical therapy
- - HAART and HIVAN
- - Renin-angiotensin system inhibition
- - Glucocorticoids
- Routine chronic kidney disease care
- Dialysis and transplantation
- SUMMARY AND RECOMMENDATIONS