Renal Disease in HIV- Should we be concerned? From Medscape

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Recent reports indicate that renal disease is becoming increasingly prevalent in HIV-infected patients.[1,2] Acute renal failure, which is common among hospitalized patients with HIV, is associated with chronic kidney disease, liver disease, and increased mortality.[3] And although death rates in HIV have declined dramatically since the introduction of highly active antiretroviral therapy (HAART),[2,4] the number of deaths due to renal disease has increased.[2]

Chronic renal disease can be caused by many pathophysiologic mechanisms that bring about HIV-associated nephropathy[1]: antiretroviral agents and related therapies have demonstrated a range of nephrotoxic effects, including (but not limited to) crystal-induced obstruction, lactic acidosis, tubular toxicity, interstitial nephritis and electrolyte abnormalities.[5]

A prospective, multicenter, observational cohort study of participants in the HIV Outpatient Study followed 6945 HIV-infected patients for a median of 39.2 months.[4] An increase in the rates of non-AIDS-defining illnesses was observed — 42.5% in 2004, compared to 13.1% in 1996. Among the causes of death that showed a proportional increase in this study were renal disease, liver disease, bacteremia and sepsis, gastrointestinal diseases, and non-AIDS-related malignancies.

A separate analysis of the cause of mortality in HIV-infected individuals found that 32% of deaths among patients in the post HAART era were non-HIV-related, compared with just 9% in the pre-HAART era.[6] The investigators suggest that this shift in the causes of death toward non-HIV-related factors indicates that a more comprehensive health care approach may be needed for optimal life expectancy.

According to Joerg Röling and colleagues at the Ludwig-Maximilians-Universitat in Germany, increased life expectancy and alterations in lipid metabolism among HAART-treated patients are likely to continue to result in increases in the prevalence of diabetes and hypertension and subsequent secondary renal disease.[1] This trend underscores the importance of a proactive approach to identifying renal disease in HIV-infected patients.

Find out more about guidelines for appropriately screeningHIV-infected patients for renal disease.

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