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World J Nephrol. Jul 6, 2015; 4(3): 388-395
Published online Jul 6, 2015. doi: 10.5527/wjn.v4.i3.388
Epidemiology, clinical characteristics, and management of chronic kidney disease in human immunodeficiency virus-infected patients
Minoru Ando, Naoki Yanagisawa
Minoru Ando, Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
Naoki Yanagisawa, Division of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
Author contributions: Ando M and Yanagisawa N contributed equally to this work, and generated the figures and tables; Ando M chiefly wrote the manuscript.
Conflict-of-interest statment: None declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Minoru Ando, MD, PhD, Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo 113-8677, Japan. hdcn@cick.jp
Telephone: +81-3-38232101 Fax: +81-3-38241552
Received: June 24, 2014
Peer-review started: June 25, 2014
First decision: September 16, 2014
Revised: October 10, 2014
Accepted: April 8, 2015
Article in press: April 9, 2015
Published online: July 6, 2015
Processing time: 377 Days and 2.5 Hours
Abstract

Antiretroviral therapy has markedly reduced acquired immune deficiency syndrome-related deaths and opportunistic infectious diseases. This has resulted in prolonged survival of individuals infected with the human immunodeficiency virus (HIV). However, this improvement in survival has been accompanied by an increase in the incidence of chronic kidney disease (CKD) and end-stage renal disease. CKD is now epidemic among HIV-infected populations in both Western and Eastern countries. Risk factors associated with CKD in HIV-infected populations include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, a low CD4 cell count, and a high HIV viral load. Clinical experience has shown that HIV-infected individuals often have one or more concurrent risk factors for CKD. The cumulative effect of multiple risk factors on the development of CKD should be noted in this population. Glomerular disease directly related to HIV infection, so-called HIV-associated nephropathy, remains an important cause of CKD among a limited HIV population of African descent, but is less likely to be common among other urban HIV populations. The impact of exposure to nephrotoxic antiretroviral agents on the development of kidney disease is both an old and a new concern. In particular, the association of tenofovir with kidney tubular injury has been an area of great interest. The findings regarding tenofovir’s adverse effect on long-term kidney function vary among studies. The early identification and treatment of CKD is recommended for reducing the burden of patients requiring dialysis in HIV-infected populations. Periodic monitoring of urinary concentrations of albumin, protein, and tubular injury markers such as low-molecular-weight proteins may be useful for the early diagnosis of patients at risk for incident CKD. This review focuses on recent epidemiology, clinical characteristics, and management of CKD in a contemporary HIV-infected population.

Keywords: Antiretroviral therapy; Tenofovir; Human immunodeficiency virus-associated nephropathy; Albuminuria; Renal tubular biomarkers; Cystatin C; Diabetes mellitus; Hypertension

Core tip: Kidneys are affected by the human immunode-

ficiency virus (HIV) and its associated therapies. As HIV subjects now have longevity while they receive combination anti-retroviral therapy (cART), kidney disease has been prominent among the current HIV subjects on cART. HIV subjects often have several coexisting risk factors of kidney disease, including diabetes and hypertension. Measurements of albuminuria, proteinuria, urinary low-molecular weight proteins, and serum cystatin C are necessary for early detection of kidney disease. Collaborative discussions between HIV experts and nephrologists are warranted to achieve the good treatment of chronic kidney disease in HIV patients.