In-Depth Review of Human Immunodeficiency Virus-Associated Nephropathy

Human Immunodeficiency Virus (HIV)-Associated Nephropathy (HIVAN) is one of the most important renal complications found in HIV-infected individuals. Morbidity and mortality in this group of patients increases due to End-Stage Renal Disease (ESRD). Classic histological characteristics of HIVAN are collapsing Focal Segmental Glomerulosclerosis (FSGS), microcystic tubular dilation and interstitial inflammation and fibrosis. High prevalence of HIVAN among people of African descent can be explained by host genetic susceptibility, which is associated with several genes on human chromosome 22. HIV can infect renal epithelial cells via unconventional mechanisms and cause changes in multiple host cellular pathways, especially in renal tubular cells and podocytes. Accurate diagnosis of HIVAN relies mainly on renal biopsy. Antiretroviral therapy is the mainstay treatment for HIVAN and current standard guidelines recommend the initiation of Highly Active Antiretroviral Therapy (HAART) in all HIV-infected individuals with HIVAN, regardless of CD4 level. Other possible treatments for HIVAN including steroids, Angiotensin Converting Enzyme (ACE) inhibitors, renal replacement therapy and renal transplantation are reviewed in this chapter.