HIV /AIDS AND ITS DIRECT EFFECT ON KIDNEYS AND EFFECT OF HIV MEDICINES on kidneys 

PROF.DRRAM ,HIV/AIDS,SEX Diseases, Hepatitis .& Deaddiction Expert 
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Renal disease is a relatively common complication in patients with human immunodeficiency virus (HIV) disease.^[1] HIV nephropathy can result from direct kidney infection with HIV or from the adverse effects of antiretroviral drugs (see the image below).^{[2, 3, 4, 5]} Further, patients with HIV disease are at risk for developing prerenal azotemia due to volume depletion resulting from salt wasting, poor nutrition, nausea, or vomiting.

HIV-associated nephropathy (HIVAN), formerly known as AIDS-associated nephropathy, is characterized by the following findings:

• Nephrotic range proteinuria
• Azotemia
• Normal to large kidneys on ultrasound images
• Normal pressure
• Focal segmental glomerulosclerosis (FSGS) on renal biopsy findings

Although FSGS is the predominant glomerular lesion in HIVAN, other reported glomerular lesions in patients with HIV include IgA nephropathy, cryoglobulinemia, amyloidosis, and a lupuslike immune complex glomerulopathy.^[6]

In the preantiretroviral therapy era, HIVAN was characterized by rapid progression to renal failure and end-stage renal disease (ESRD) leading to the need for dialysis. Highly active antiretroviral therapy (HAART) has changed the natural course of this disease, increasing the importance of prompt diagnosis and proper care. Baseline estimated glomerular filtration should be obtained and renal function monitored during HAART.^[7] Physicians must consider HIVAN in patients who develop proteinuria.

For other discussions on management of HIV infection, see HIV Disease, Pediatric HIV Infection, and Antiretroviral Therapy for HIV Infection.

For patient education information, see the Immune System Center and Sexually Transmitted Diseases Center, as well as HIV/AIDS and Rapid Oral HIV Test.