Kidney Disease in HIV: Moving beyond HIV-Associated Nephropathy

J Am Soc Nephrol. 2017 Nov;28(11):3142-3154. doi: 10.1681/ASN.2017040468. Epub 2017 Aug 7.

Abstract

In developed countries, remarkable advances in antiretroviral therapy have transformed HIV infection into a chronic condition. As a result, HIV-associated nephropathy, the classic HIV-driven kidney lesion among individuals of African descent, has largely disappeared in these regions. However, HIV-positive blacks continue to have much higher rates of ESRD than HIV-positive whites, which could be attributed to the APOL1 renal risk variants. Additionally, HIV-positive individuals face adverse consequences beyond HIV itself, including traditional risk factors for CKD and nephrotoxic effects of antiretroviral therapy. Concerns for nephrotoxicity also extend to HIV-negative individuals using tenofovir disoproxil fumarate-based pre-exposure prophylaxis for the prevention of HIV infection. Therefore, CKD remains an important comorbid condition in the HIV-positive population and an emerging concern among HIV-negative persons receiving pre-exposure prophylaxis. With the improved longevity of HIV-positive individuals, a kidney transplant has become a viable option for many who have progressed to ESRD. Herein, we review the growing knowledge regarding the APOL1 renal risk variants in the context of HIV infection, antiretroviral therapy-related nephrotoxicity, and developments in kidney transplantation among HIV-positive individuals.

Keywords: Apolipoprotein L1; HIV nephropathy; chronic kidney disease.

Publication types

  • Review

MeSH terms

  • AIDS-Associated Nephropathy / etiology
  • Anti-Retroviral Agents / adverse effects
  • Apolipoprotein L1
  • Apolipoproteins / genetics
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Kidney Transplantation
  • Lipoproteins, HDL / genetics
  • Renal Insufficiency, Chronic / etiology*
  • Renal Insufficiency, Chronic / genetics
  • Renal Insufficiency, Chronic / surgery
  • Risk Factors
  • Tenofovir / adverse effects

Substances

  • APOL1 protein, human
  • Anti-Retroviral Agents
  • Apolipoprotein L1
  • Apolipoproteins
  • Lipoproteins, HDL
  • Tenofovir