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Renal disease: the effects of HIV and antiretroviral therapy and the implications for early antiretroviral therapy initiation

Szczech, Lynda Anne

Current Opinion in HIV & AIDS: May 2009 - Volume 4 - Issue 3 - p 167–170
doi: 10.1097/COH.0b013e328329c646
Early treatment: Edited by Sean Emery and Andrew Phillips

Purpose of the review: This review will summarize the relevant literature supporting the early initiation of antiretroviral therapy among persons with HIV and kidney disease.

Recent findings: Recent guidelines support the initiation of antiretroviral therapy among persons with HIVAN as soon as the diagnosis of kidney disease is made. However, few patients with HIV and kidney disease undergo renal biopsy to determine the histology of their renal lesion. Observational studies, however, suggest that antiretroviral therapy is associated with a lesser risk of new AIDS defining illness and mortality associated with the presence of proteinuria or increased creatinine. These abnormalities are seen in a larger proportion of persons with HIV than only those that undergo biopsy. Therefore, these markers could describe the subgroup of patients at highest risk of poor outcomes and potentially prompt the consideration of earlier initiation of therapy on an individual basis.

Summary: Early initiation of antiretroviral therapy probably improves outcomes among persons with HIVAN. The presence of proteinuria or an elevated creatinine could prompt consideration for early initiation of antiretroviral therapy on a case-by-case basis.

Duke University Medical Center, Department of Medicine, Division of Nephrology, Durham, North Carolina, USA

Correspondence to Lynda Anne Szczech, MD, MSCE, Duke University Medical Center, Box 3646, Durham, NC 27710, USA Tel: +1 919 668 8008; fax: +1 919 668 7128; e-mail: szcze001@mc.duke.edu

© 2009 Lippincott Williams & Wilkins, Inc.