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Overview of kidney disease in HIV-positive patients

Authors
Christina M Wyatt, MD
Paul E Klotman, MD
Section Editors
Richard J Glassock, MD, MACP
Fernando C Fervenza, MD, PhD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

With dramatic improvements in survival and disease progression in the era of combination antiretroviral therapy (ART), complications such as kidney, liver, and cardiac disease have largely replaced opportunistic infections as the leading causes of mortality in the setting of HIV [1]. Patients with HIV are at risk for both acute kidney injury (AKI) and chronic kidney disease (CKD) [2], secondary to medication nephrotoxicity, HIV-associated nephropathy (HIVAN) [3-6], immune complex kidney diseases [6-10], and, less commonly, kidney disease in the setting of thrombotic microangiopathy [11,12]. In addition, the aging cohort of HIV-positive patients may be at increased risk for kidney disease related to hepatitis B or C virus co-infection [6,13,14] and comorbid or treatment-related diabetes and hypertension.

ACUTE KIDNEY INJURY

Epidemiology of AKI in HIV-positive patients — Prior to the introduction of combination antiretroviral therapy (ART), acute kidney injury (AKI) was commonly attributed to septicemia, volume depletion, or medication toxicity [15,16].

Incidence of AKI — The incidence of AKI in HIV-positive patients is higher than it is in patients without HIV. The incidence of AKI in patients with HIV has also increased over time. This was documented in a study of hospitalized adults in New York state which compared administrative data from 1995 (before the introduction of ART) to data from 2003 (after the introduction of ART) [17]. Compared with HIV-negative hospitalized patients, AKI was documented in a significantly greater proportion of HIV-positive hospitalized patients, both in 1995 (2.9 versus 1 percent) and 2003 (6 versus 2.7 percent). Among HIV-positive patients, the proportion with documented AKI was two-fold higher in 2003, although in-hospital mortality was lower.

In a prospective study of 754 ambulatory HIV-positive patients followed at a single center, at least one episode of AKI occurred in 71 patients (9.4 percent) during a two-year period (2000 to 2002, after the introduction of ART) [18].

Risk factors for AKI — Some risk factors for AKI among HIV-positive patients are similar to risk factors for AKI in the general population, such as older age, diabetes mellitus, preexisting chronic kidney disease (CKD), and acute or chronic liver disease [17]. However, some risk factors are specific to HIV. In the study of 754 HIV-positive patients mentioned above, for example, AKI occurred more frequently among those receiving ART (12 versus 4 percent) and those with an AIDS-defining illness (30 versus 7 percent) [18]. Other predictors of AKI included low CD4 count, high viral load, and co-infection with hepatitis C virus (HCV).

             

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Literature review current through: Nov 2016. | This topic last updated: Wed Mar 11 00:00:00 GMT 2015.
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