Human immunodeficiency virus and dialysis
- Paul E Klotman, MD
Paul E Klotman, MD
- President, CEO, and Executive Dean
- Baylor College of Medicine
- Christina M Wyatt, MD
Christina M Wyatt, MD
- Associate Professor
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
Kidney disease is an important complication of human immunodeficiency virus (HIV) infection, particularly in African Americans . A collapsing form of focal segmental glomerulosclerosis (FSGS) with associated tubular microcysts and interstitial inflammation is the classic form of HIV-related kidney disease, known as HIV-associated nephropathy (HIVAN). HIV infection has also been associated with other forms of kidney disease, in particular, immune complex disease . With prolonged survival and aging of the population, HIV-positive patients are also at increasing risk for kidney disease due to comorbid conditions, such as diabetes and hypertension.
Some of these kidney diseases can result in end-stage renal disease (ESRD). Issues relating to HIV and dialysis will be reviewed here. HIV-related disorders of the kidney are discussed separately. (See "Overview of kidney disease in HIV-positive patients" and "HIV-associated nephropathy (HIVAN)".)
Compared with the general population, HIV-positive patients are at increased risk for end-stage renal disease (ESRD). In a population-based cohort study from Denmark, HIV-positive individuals had a fourfold higher risk of ESRD compared with age- and gender-matched controls . Data from the Veterans Affairs (VA) healthcare system have demonstrated that the risk of ESRD is associated with both HIV-related factors (high HIV-RNA, low CD4, and hepatitis C virus coinfection) and traditional kidney disease risk factors (diabetes, hypertension, and cardiovascular disease) . A subsequent study from the VA suggests that ESRD may occur at a younger age in HIV-positive versus HIV-negative veterans, although the difference is small .
Both HIV-related factors and traditional renal risk factors were also associated with a combined endpoint of ESRD and advanced chronic kidney disease in two large HIV cohort studies, D:A:D and EuroSIDA [6,7]. In a smaller, retrospective cohort study from Germany, injection drug use and black race were the only independent risk factors for ESRD in HIV-positive adults . Over the 20-year study period, these authors observed a decline in the prevalence of ESRD among HIV-positive blacks and an increase in the prevalence of ESRD among HIV-positive whites, although the racial disparity in ESRD risk remained significant.
Data from the VA healthcare system and from the Johns Hopkins HIV cohort have also demonstrated a striking disparity in the risk of ESRD among HIV-positive blacks, who may have as much as a 30-fold increase in the risk of ESRD compared with HIV-positive whites [9-11]. In the VA cohort, the risk of ESRD among HIV-positive blacks was similar to that observed among diabetics . Genetic variability in the APOL1 gene on chromosome 22 appears to account for a significant proportion of the racial disparity in ESRD risk, including the risk of HIV-associated nephropathy (HIVAN) and other forms of focal segmental glomerulosclerosis (FSGS) [12-14]. (See "Epidemiology, classification, and pathogenesis of focal segmental glomerulosclerosis", section on 'FSGS in African Americans'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Prevalence of human immunodeficiency virus infection in the dialysis population
- HUMAN IMMUNODEFICIENCY VIRUS TESTING
- False-positive results
- TRANSMISSION IN THE DIALYSIS UNIT
- Dialysis isolation
- Patient-to-patient transmission
- Needlestick transmission
- Viral levels in ultrafiltrate
- ISSUES RELATED TO DIALYSIS MODALITY
- Hemodialysis access infections and complications
- Dialyzer reuse
- ANTIRETROVIRAL THERAPY
- SUMMARY AND RECOMMENDATIONS