HIV-Associated Renal Diseases and Highly Active Antiretroviral Therapy--Induced Nephropathy

Abstract

Renal disease is becoming an increasingly prevalent entity in human immunodeficiency virus (HIV)-infected patients; it occurs in a variety of clinical settings and is associated with histopathological changes. HIV-related renal impairment can present as acute or chronic kidney disease; it can be caused directly or indirectly by HIV and/or by drug-related effects that are directly nephrotoxic or lead to changes in renal function by inducing metabolic vaculopathy and renal damage. Acute renal failure is frequently caused by the toxic effects of antiretroviral therapy or nephrotoxic antimicrobial substances used in the treatment of opportunistic infections. Chronic renal disease can be caused by multiple pathophysiological mechanisms, leading to HIV-associated nephropathy, a form of collapsing focal glomerulosclerosis, thrombotic microangiopathy, and various forms of immune complex glomerulonephritis. The increase in life expectancy and alteration of lipid metabolism due to receipt of highly active antiretroviral therapy are expected to result in an increased prevalence of diabetes and hypertension and, thus, to secondary diabetic and hypertensive renal damage. Antiretroviral agents, such as indinavir and tenofovir, have been associated with nephrotoxic drug effects that have been shown to be reversible in most cases. In this article, we review the current knowledge about acute and chronic HIV-associated renal disease, metabolic alterations and related nephropathies, and toxic drug effects of combination antiretroviral pharmacotherapy.

Cardiovascular complications in the acquired immunodeficiency syndrome

“…Endothelial dysfunction has been described in association with visceral fat accumulation and related metabolic alterations (e.g., insulin resistance) and activation of proinflammatory cytokines (TNF-alpha, IL-6), as well as with a direct action of drugs included in HAART regimens. HIV-associated renal impairment can present as acute or chronic kidney disease; it can be caused directly or indirectly by HIV-1 and/or by drug-related effects that are directly nephrotoxic or lead to changes in renal function by inducing metabolic vasculopathy and renal damage 80 . Chronic renal disease can be caused by multiple pathophysiologic mechanisms, leading to HIV-associated nephropathy, a form of collapsing focal glomerulosclerosis, thrombotic microangiopathy, and various forms of immune complex glomerulonephritis 80 .…”

“…HIV-associated renal impairment can present as acute or chronic kidney disease; it can be caused directly or indirectly by HIV-1 and/or by drug-related effects that are directly nephrotoxic or lead to changes in renal function by inducing metabolic vasculopathy and renal damage 80 . Chronic renal disease can be caused by multiple pathophysiologic mechanisms, leading to HIV-associated nephropathy, a form of collapsing focal glomerulosclerosis, thrombotic microangiopathy, and various forms of immune complex glomerulonephritis 80 . Arterial hypertension, even in agreement with the Adult Treatment Panel-III guidelines 81 , is currently considered part of HAART-associated metabolic syndrome 82 .…”

Evaluation of glomerular filtration rate in HIV-1-infected patients before and after combined antiretroviral therapy exposure*

“…metabolic alterations, diabetes, hypertension and cardiovascular events) [12][13][14]. It has been hypothesized that antiretroviral medications may have a direct effect in increasing the risk of renal dysfunction, and a variety of cART-related effects, including proteinuria, renal tubular damage, interstitial nephritis and overall declines in glomerular filtration rates, have been noted [15][16][17][18][19][20][21][22][23].…”

Prospective study of renal abnormalities in HIV seropositive patients

“…HIV associated renal impairment can be acute or chronic; it can be due to direct or indirect effects of HIV or drug related effects that are directly nephrotoxic or can induce metabolic vasculopathy and renal damage. 1,2 The most common cause of renal failure in HIV patients is the syndrome of HIV-associated nephropathy. 3,4 Reports from Miami and New York workers depicted a characteristic renal lesion named HIV-associated nephropathy (HIVAN).…”