The Changing Epidemiology of HIV-related Chronic Kidney Disease in the Era of Antiretroviral Therapy

Kidney Int. 2014 Aug;86(2):259-65. doi: 10.1038/ki.2014.44. Epub 2014 Feb 26.

Abstract

The epidemiology of kidney disease in HIV-infected individuals has changed significantly since the introduction of combination antiretroviral therapy (cART) in the mid 1990s. HIV-associated nephropathy (HIVAN), an aggressive form of collapsing focal segmental glomerulosclerosis (FSGS) caused by direct HIV infection of the kidney in a genetically susceptible host, emerged early in the HIV epidemic as a leading cause of end-stage renal disease. With the widespread use of cART, HIVAN is increasingly rare in populations with access to care, and the spectrum of HIV-related chronic kidney disease now reflects the growing burden of comorbid disease in the aging HIV population. Nonetheless, available data suggest that both HIV infection and cART nephrotoxicity continue to contribute to the increased risk of chronic kidney disease in HIV-infected individuals in the United States and Europe. Despite the genetic susceptibility to HIVAN in individuals of West African descent, limited data are available to define the prevalence and spectrum of HIV-related kidney disease in sub-Saharan Africa, which is home to two-thirds of the world's HIV population. In this mini-review, we characterize the changing epidemiology of HIV-related chronic kidney disease in Western nations and in sub-Saharan Africa.

Publication types

  • Review

MeSH terms

  • AIDS-Associated Nephropathy / drug therapy
  • AIDS-Associated Nephropathy / epidemiology*
  • Africa South of the Sahara / epidemiology
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use
  • Coinfection / epidemiology
  • Diabetes Complications / epidemiology
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / epidemiology
  • Humans
  • Hypertension / complications
  • Hypertension / epidemiology
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / epidemiology*
  • United States / epidemiology

Substances

  • Anti-HIV Agents