Pharmacotherapy for Human Immunodeficiency Virus—Associated Nephropathy

Abstract

Approximately 10% of adult patients with human immunodeficiency virus (HIV) infection have HIV-associated nephropathy (HIVAN). This condition, a leading cause of renal failure, is characterized by damage to specific areas of the renal filtration system. It manifests with increased serum creatinine levels, overt proteinuria, and in some patients, end-stage renal disease (ESRD). The mortality rate for HIVAN-related ESRD is high-30% within the first year of onset. Most instances of HIVAN occur in patients of African descent. Although advances in defining the pathology have been made, the optimal treatment strategy remains unclear. Potential benefits of potent combination antiretroviral therapy, angiotensin-converting enzyme (ACE) inhibitors, and corticosteroids have been reported in small clinical trials and case reports. Cyclosporine is another option, but clinical experience with this agent in managing HIVAN is limited. Few conclusions can be drawn from the limited body of available evidence. Antiretroviral therapy, ACE inhibitors, and corticosteroids are possibly associated with reversal of serum creatinine level increases and proteinuria, but studies are necessary to further define the role of these agents in therapy. Close monitoring is advised when treating any patient with HIVAN.

Pharmacotherapy and treatment options for HIV-associated nephropathy

“…From a clinical standpoint, a number of case reports and small studies have investigated the role of angiotensin-converting enzyme (ACE) inhibition in HIVAN. (49, 50) Kimmel et al . published a matched cohort study of 18 patients with biopsy proven HIVAN, 9 of whom received captopril and 9 without ACE inhibitor (ACEi) therapy.…”

Human Immunodeficiency Virus Infection and the Kidney

“…There are isolated case reports of improvement of renal function and, in some cases, regression of histologic lesions with ART. 10,11 For ethical reasons, a rando mized control trial of this hypothesis has not and will not be undertaken.…”