HIV-Associated Nephropathy in the Era of Antiretroviral Therapy

With improved survival in the era of antiretroviral therapy, kidney disease has emerged as an important complication of Human Immunodeficiency Virus (HIV) infection and antiretroviral therapy. The classic kidney disease of HIV infection, HIV-associated nephropathy, occurs almost exclusively in patients of African descent. HIV-associated nephropathy is characterized by collapsing focal segmental glomerulosclerosis with associated tubular dilatation and interstitial inflammation, although the histology may be more subtle in patients receiving antiretroviral therapy. Renal epithelial cells are infected by HIV-1, which results in epithelial cell proliferation and induction of local inflammatory pathways. Even with appropriate therapy, the kidney is a reservoir for HIV-1. Although the widespread introduction of antiretroviral therapy has had a beneficial impact on the epidemiology of HIV-associated nephropathy, the burden of kidney disease is likely to increase as a result of antiretroviral toxicity, reduction in competing mortality risks, and the increasing prevalence of HIV-1 infection in patients at risk for kidney disease.