Stable improvement of renal function after initiation of highly active anti-retroviral therapy in patients with HIV-1-associated nephropathy (original) (raw)
Related papers
Observations on HIV-Associated Renal Disease in the Era of Highly Active Antiretroviral Therapy
The American Journal of the Medical Sciences, 2002
Background: Renal disease in patients infected with HIV has evolved to include several lesions, including HIV-associated nephropathy (HIV-AN), which can promote progressive loss of renal function. Although angiotensin-converting enzyme inhibitors and corticosteroids are beneficial in selected patients, the effect of highly active antiretroviral therapy (HAART) on renal function is currently being explored. Methods: We undertook a retrospective study to determine the types of renal lesions present in patients infected with HIV with renal insufficiency and/or proteinuria during the era of HAART availability and the effect of HAART on renal outcomes in these patients. Patients with HIV infection referred to the renal clinic from July 1996 through December 2000 were evaluated. Patient characteristics and data were collected including CD4 count, viral load, serum creatinine, blood pressure, proteinuria, renal ultrasound, and biopsy results, and treatment with HAART. Study endpoints were doubling of serum creatinine, initiation of dialysis, or death. Results: Twenty-three patients met study criteria, 13 received HAART, and 10 did not. Baseline characteristics were similar except for renal function parameters, viral loads, and CD4 counts. A variety of lesions were noted on 12 renal biopsies. A clinical diagnosis of HIV-AN was made in the other 11 patients. Only 2 patients receiving HAART before renal evaluation were noted to have HIV-AN. In the HAART group, none of the patients, including those with HIV-AN, developed a doubling of serum creatinine. In the non-HAART group, all patients manifested a doubling of serum creatinine, 2 patients died, and 8 patients required dialysis. Conclusions: A variety of renal lesions are noted in patients infected with HIV during the HAART era. Patients who received HAART maintained stable renal function, whereas patients who did not required dialysis therapy or died with advanced renal failure. It seems that HAART may improve renal outcomes in patients with HIV and renal disease. [Am J Med Sci 2002;323(2):102-106.]
Presentation of HIV-associated nephropathy and outcome in HAART-treated patients
Nephrology Dialysis Transplantation, 2012
Background. Among the numerous renal diseases observed in human immunodeficiency virus (HIV) patients, HIV-associated nephropathy (HIVAN) is a major cause of end-stage renal disease (ESRD). The purpose of our study was to describe the presentation and outcome of HIVAN in the era of highly active antiretroviral therapy (HAART). Methods. We analysed clinical features and outcome of 57 patients with histologically proven HIVAN diagnosed between 2000 and 2009 in four teaching hospitals in Paris, France.
HIV-Associated Nephropathy ( HIVAN ) : Hope rising !
HIVAN, the commonest renal complication of HI V/ .-\IDS is most prevalent among blacks of African descent. Before the advent of HAART, HIVAN was inevitably fatal within a short period. However, with the introduction of highly active anti-retroviral therapy .H:\ART), the prognosis of HI VAN has dramatically improved. Angiotensin-converting enzyme (ACE) inhibitors and corticosteroids have also improved the treatment outcome of HI VAN. Patients with HIVAN ;U~now being offered renal replacement therapy .dialysis and transplantation) more readily than in the past and new therapeutic strategies against HIVAN are being devised. The racial predilection of HI VAÑ \\ever, warrants further investigation.
HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management
Expert Review of Anti-infective Therapy, 2008
Initially described in 1984, human immunodeficiency virus-associated nephropathy (HIVAN) has now become a common disease within the HIV-seropositive population. It is a focal segmental glomerulosclerosis causing rapid deterioration of renal function. It is the most common cause of chronic renal disease in HIV patients and occurs almost exclusively in blacks. Through murine and human studies, it is now clear that HIVAN is caused by a direct effect of infection of renal cells by HIV-1 and that the virus actively replicates within renal cells. How the virus causes disease within cells is not yet understood, but there is evidence for factors within infected cells causing both proliferation and apoptosis. Steroids, angiotensin converting enzyme (ACE) inhibitors, and highly active antiretroviral therapy (HAART) have been used for the treatment of HIVAN, with HAART, in particular, showing a dramatic improvement in both the pathologic changes and clinical course of HIVAN.
Recent developments in HIV-related kidney disease
HIV Therapy, 2010
Although kidney disease has been a recognized complication of HIV infection since the beginning of the HIV epidemic, its epidemiology, underlying causes and treatment have evolved in developed countries where highly active antiretroviral therapy (HAART) has been widely available. HIV-associated nephropathy and HIV immune complex-mediated kidney disease were the prominent renal diagnoses in the earlier period of the HIV epidemic. While HIV immune complex-mediated kidney disease remains a common finding among HIV-infected individuals with kidney disease, the incidence of HIV-associated nephropathy has been diminishing in developed countries. The role of the metabolic effects of long-term HAART exposure and nephrotoxicity of certain antiretroviral medications on the development and progression of chronic kidney disease is now of increasing concern. The long-term clinical implications of acute kidney injury among HIV-infected persons are increasingly recognized. Kidney disease in HIV-in...
Interventions for HIV-associated nephropathy (Review)
2013
References to studies awaiting assessment Keryx Biopharmaceuticals 2001 {published data only} Keryx Biopharmaceuticals. Keryx Biopharmaceuticals to initiate Phase II clinical trial of KRX-101 for the treatment of AIDSrelated kidney disease-HIV-associated nephropathy (HIVAN): HIVAN is a life-threatening complication of AIDS (published January 29th 2001). http://investors.keryx.com/phoenix.zhtml? c=122201&p=irol-newsArticle_print&ID=869589&highlight= (accessed 29 October 2012). References to ongoing studies Kalayjian 1995b {unpublished data only} Kalayjian R, Smith MC, Lederman M. A phase II randomised, double-blind, placebo-controlled trial to determine the e icacy of prednisolone therapy in HIV-Associated Nephropathy (HIVAN).
This cohort study performed from April 6th, 2017 to May 8th 2018 aimed at optimizing the biomedical follow-up of HIV-associated nephropathy by highlighting the beneficial effect of HIV-2 on the progression of this condition among patients with dual infection (HIV-1 and HIV-2) under Highly Active Antiretroviral Therapy (HAART). Our data show an overall prevalence of 40.4% for HIV-associated nephropathy cases with 30.8% cases for patients with dual infection (HIV-1 and HIV-2) and 69.2% cases for patients only infected with HIV-1 (p=0.001). In this cohort, 257 people were newly diagnosed positive for HIV infection, and displayed a nephrotic syndrome with a focal and segmental glomerulosclerosis more or less associated with a high blood pressure or edema of the lower limbs or a renal insufficiency. These participants registered at the Bertoua day hospital (East Region from Cameroon) for the HAART follow-up. HIV-associated Nephropathy was in most cases, the circumstance of discovery for HIV infection and had a slower progression time among patients with dual infection (HIV-1 and HIV-2) compared to patients only infected with HIV-1. This slow progression time observed among patients with dual infection (HIV-1 and HIV-2) was also positively correlated with a shorter renal function recovery time (7±1.09 months) than the one observed among patients only infected with HIV-1 (11±6.02 months) OR=0.76 [IC 95% (0.18-1.71)] (p=0.05). Keywords: HIV-associated nephropathy, dual infection HIV-1/HIV-2, HAART, Proteinuria
HIV and renal disease: a contemporary review
International journal of STD & AIDS, 2018
The presence of human immunodeficiency virus (HIV)-related kidney disease is an important cause of mortality and morbidity. HIV infection induces renal injury by direct cytotoxicity or immune complex-mediated glomerulonephritis in patients with genetic susceptibility factors. In the last decades, with the development and diffusion of combination antiretroviral therapy, which has prolonged patient survival, there has been a shift in the spectrum of renal diseases in HIV-infected patients, with the decrease of glomerular diseases and increase in the role of nephrotoxicity and co-morbidities. This review provides a contemporary and critical review on the main renal syndromes occurring in HIV-infected patients.
Antiretroviral therapy in the treatment of HIV-associated nephropathy
Nephrology Dialysis Transplantation, 2006
Background. The effect of antiretroviral therapy (ART) on the clinical course of patients with human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is not well-established. This study was undertaken to further elucidate the potential benefit of ART in HIV-infected patients with documented HIVAN. Methods. A cohort of 263 consecutive HIV-infected patients referred to the Johns Hopkins renal clinic from 1995 to 2004 was examined. Patients were included if they had biopsy-proven HIVAN and did not require dialysis within 1 month of their kidney biopsy. The cumulative probability of renal survival was calculated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox regression method. Results. Fifty-three patients among 152 biopsied patients had HIVAN. Among 36 patients who met the inclusion criteria, 26 were treated with ART (group I) and 10 patients were not (group II). Except for age, baseline demographics and clinical characteristics were similar in the two groups. Renal survival was significantly better in the group receiving ART by both univariate (P ¼ 0.025) and multivariate analysis (overall adjusted hazard ratio ¼ 0.30; 95% confidence interval 0.09-0.98; P < 0.05) for ART compared with no treatment. Conclusions. Patients with biopsy-proven HIVAN treated with ART had better renal survival compared with patients who did not receive ART. HIVAN should be considered as an indication to initiate ART.