HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention

Abstract

The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms “HIVAN” and “pathology and clinical presentation”, in addition to “prevalence and risk factors for HIVAN”, with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/µL. Other clinical presentations in African populations include acute kidney injury (AKI), nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN.

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

“…Renal impairment was a frequent finding among our study patients and has been linked to HIV disease progression, anaemia and poor outcomes in both wealthy and resource limited settings [56][57][58][59]. Evaluation of renal function is an important component of severe anaemia treatment protocols [34,57] since it may affect the choice of ART [56,60].…”

Comparative evaluation of liver, spleen, and kidney stiffness in HIV-monoinfected pediatric patients via shear wave elastography

“…Similarly, portal hypertension secondary to chronic liver disease, immunologic activation, and malignancy can change the parenchymal architecture of the spleen [3,4]. Glomerular and tubular interstitial involvements can also cause acute and chronic renal disorders in HIV-infected children [5,6].…”

Human Immunodeficiency Virus Nephropathy in Central Africa: The Value of Renal Ultrasound

“…Kidney disease, which is a common complication of HIV infection and its treatment (Ross, 2014), may shorten the lifespan of affected patients. Its early detection may be beneficial for the indication of treatment and hence prevention of progression to the end-stage renal failure requiring dialyze (Ikpeme, Ekrikpo, Akpan, & Ekaidem, 2012;Husain et al, 2018). Although the kidney biopsy remains the gold standard to make the definitive diagnosis (Waheed & Atta, 2014), it is often not performed in many regions of sub-Saharan Africa (Wearne & Okpechi, 2016).…”