David Gracey1,2 Renal Unit and Renal Transplant Unit, Statewide Renal Service, Royal Prince Alfred Hospital, Camperdown, NSW Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW Last reviewed: November 2019 Introduction Renal disease has emerged as one of the predominant non-infectious comorbidities (NICMs) seen among people with human immunodeficiency virus (HIV) infection1,2. It …
CKD is reported commonly in people with HIV infection, although estimates of the prevalence of renal disease vary according to study design, location and the definition of renal impairment used11. A global prevalence of CKD of 6.4% in HIV-infected patients using the MDRD formula, or 4.8% using the CKD-EPI formula, has been reported in a …
Epidemiology of renal disease in HIV-infected people Read More »
Risk factors associated with an increased risk of CKD are well recognised. Some of these are modifiable, emphasising the importance of their early detection and management19. Renal risk factors may be specific to patients with HIV; other ‘traditional’ renal risk factors have overlap with those seen in the HIV non-infected patient group, as shown in …
Risk factors for renal disease in HIV-infected people Read More »
Clinically, CKD is often asymptomatic and is often detected on routine screening22. Patients who are at risk for renal disease should be routinely screened for the presence of CKD23. In addition to a full clinical assessment for risk factors for renal disease and measurement of blood pressure, at risk patients should have a urine test …
If a patient’s baseline screening tests or clinical assessment demonstrate an abnormality, underlying reasons for renal disease should be sought. Further investigation of the aetiology of renal impairment may be required, and referral to a Nephrologist is recommended if there is CKD, significant proteinuria, haematuria or difficult-to-control hypertension29. Referral to a Nephrologist should also be …
HIVAN and HIV immune complex kidney (HIVICK) disease are the most frequent forms of renal disease directly related to HIV infection37. HIVAN is seen almost always in patients with advanced HIV infection and occurs predominantly in patients of African descent, explained by a genetic predisposition. Increased susceptibility to HIVAN among this group of patients is …
In addition to those conditions mentioned above, data suggest a role for antiretroviral drugs in adding to the risk of CKD in patients with HIV infection45. The risk of CKD relates not only to the use of potentially nephrotoxic antiretroviral drugs but also to the patient’s comorbid conditions, polypharmacy and advancing age, as well as to …
CKD has important implications for clinical outcomes, with a higher burden of morbidity and mortality. It is associated particularly with ESRD and a high burden of cardiovascular disease37. Patients with HIV infection and renal impairment in the presence of albuminuria are at particular risk of increased morbidity and mortality54. These patients should be closely assessed for …
Treatment of renal disease in people with HIV infection Read More »
The number of HIV-infected patients with ESRD is increasing55. These patients may require treatment with dialysis or renal transplantation, usually in centres with expertise in this area. The one-year survival rate of patients with HIV infection on dialysis has improved recently, although the rate remains inferior to that of the population without HIV infection56. These …
HIV-infected patients are at particular risk of CKD, which is often related to CNICM, such as diabetes and hypertension. Non-infectious comorbidities are increasingly common, with the increased survival and ageing of the HIV-infected patient population. CKD in HIV-infected patients is associated with poorer patient outcomes, including higher morbidity and mortality. CKD is often associated with …
Developing a sustainable HIV, Viral Hepatitis and Sexual Health Workforce
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