Key considerations for people living with HIV

HIV-related renal impairment (RI) can present as acute renal failure (ARF) or chronic kidney disease (CKD), caused directly or indirectly by HIV and/or due to drug-related effects.1

  • ARF may be associated with antiretroviral therapy (ART), or treatment for HIV- associated opportunistic infections.
  • CKD disease can be caused by multiple pathophysiological mechanisms, including HIV-associated nephropathy (HIVAN).1
     

Find out more on the spectrum of kidney diseases in HIV-infected patients.2



In the HIV outpatient study (HOPS), the proportion of deaths involving renal disease significantly increased during the period from 1996 to 2004 (p=0.037) as deaths from AIDS declined with the introduction of effective antiretroviral therapy.3 



Markers of kidney function are abnormal in up to 30% of HIV-infected patients.4 AIDS-related kidney disease has become a common cause of end stage renal disease (ESRD) requiring dialysis4, and kidney disease may be associated with hospitalisation, progression to AIDS and death.4,5

  • Diabetes mellitus and hypertension are the commonest causes of CKD in the general population and the prevalence of these conditions is increasing in HIV-infected people.5
  • Abnormal renal function has been shown to be an independent predictor of mortality in people living with HIV (PLWHIV).
  • The higher prevalence of RI in HIV-infected patients has been demonstrated in a study in which RI prevalence was higher in women, older patients (>50 years), and those with a low body mass index (BMI).7
  • CKD occurs at an increased frequency and with accelerated progression in HIV-infected people of black race.5 HIVAN has been shown to occur primarily in patients of African descent, suggesting a genetic predisposition.1
  • Exposure to certain ARV drugs such as indinavir and tenofovir may be associated with a higher RI prevalence in PLWHIV.7
  • although there are a number of studies that demonstrate an association of tenofovir with renal impairment,8 other studies have demonstrated no such association. The subject remains under investigation.1 
     

Find out more about causes of RI or about risk factors for the development of RI.

  • A retrospective observational study in Europe found a 3% prevalence of CKD in PLWHIV. In this study CKD development was associated with:
    • >50 years age
    • lower CD4 cell counts.9 
       

ARVs may be directly nephrotoxic or may lead to changes in renal function by inducing metabolic vasculopathy and/or renal damage.1 The overall survival improvement of HIV-infected patients receiving ARVs leads to an increase in factors associated with deterioration in renal function - these include:

  • aging
  • comorbidities (including high blood pressure, diabetes, and hyperlipidemia)
  • adverse effects of ARV drugs.7
  • poor quality of life.10 
     

References

  1. Röling J, Schmid H, Fischereder M, Draenert R, Goebel FD. HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy. Clin Infect Dis. 2006;42:1488–1495.
  2. Elewa U, Sandri AM, Rizza SA, Fervenza FC. Treatment of HIV-associated nephropathies. Nephron Clin Pract. 2011;118:c346–354.
  3. Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43:27–34.
  4. Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the Management of Chronic Kidney Disease in HIV-Infected Patients: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2005;40:1559–1585.
  5. Winston J, Deray G, Hawkins T, Szczech L, Wyatt C, Young B. Kidney disease in patients with HIV infection and AIDS. Clin Infect Dis. 2008;47:1449–1457.
  6. Szczech LA, Hoover DR, Feldman JG, et al. Association between renal disease and outcomes among HIV-infected women receiving or not receiving antiretroviral therapy. Clin Infect Dis. 2004;39:1199–1206.
  7. Déti EK, Thiébaut R, Bonnet F, et al. Prevalence and factors associated with renal impairment in HIV-infected patients, ANRS C03 Aquitaine Cohort, France. HIV Med. 2010;11:308–317.
  8. Mocroft A, Kirk O, Reiss P, et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS. 2010;24:1667–1678.
  9. Colson AW, Florence E, Augustijn H, Verpooten GA, Lynen L, Gheuens E. Prevalence of chronic renal failure stage 3 or more in HIV-infected patients in Antwerp: an observational study. Acta Clin Belg. 2010;65:392–398.
  10. Boulware LE, Jaar BG, Tarver-Carr ME, Brancati FL, Powe NR. Screening for proteinuria in US adults: a cost-effectiveness analysis. JAMA. 2003;290:3101–3114.