The Treatment of HIV-Associated Nephropathy

Antiretroviral therapy (ART) preserves kidney function in patients with human immunodeficiency virus (HIV)-associated nephropathy (HIVAN). Emerging data also document substantial renal benefits of ART in the general HIV-infected population, which is associated in part with suppression of HIV-1 viral replication. The extent to which the response to ART differs in persons with HIVAN compared with those with other HIV-associated kidney disorders is unknown. Beneficial effects of corticosteroids and angiotensin-converting enzyme inhibitors on kidney function also are suggested by retrospective cohort studies and uncontrolled trials of patients with HIVAN. Underexposure to ART or inadequate ART dosing in HIV-infected patients with CKD may curtail the optimal benefits that may be derived from this therapy.

Key Words: Antiretroviral therapy, HIV-associated nephropathy, Angiotensin-converting enzyme inhibitors, Prednisone, CKD