The effect of coinfection with hepatitis viruses, in particular B and C (HBV, HCV), on disease progression and survival among patients infected with HIV has become an increasing concern. Ironically, this concern has arisen from the enormously positive effects of HAART; while this improves immune function and decreases the incidence of opportunistic infections in HIV-infected patients, it also increases the contribution of chronic liver disease to the overall morbidity and mortality of these individuals. Excessive use of alcohol is an additional factor influencing HIV/HCV coinfection in this population. Approximately one-quarter of HIV-infected patients are HCV seropositive [113,114]. Among intravenous drug users with HIV, this rate is at least 50% and can be up to 90% in many populations [114,115]. Coinfection with HBV and HIV is common, with 70–90% of HIV-infected individuals having evidence of past or active HBV infection [116–118]. The prevalence of chronic carriage of HBV surface antigen among HIV-infected individuals is 1.9–9% [119,120]. Among intravenous drug users, 90% of HIV-infected individuals have evidence of exposure to HBV (hepatitis B core antibody positivity) and 60% also have evidence of past infection with the presence of HBV surface antibody .
Prevalence of renal disorders has not been reported in HIV/hepatitis coinfected populations. However, proteinuria and haematuria have been reported frequently in HCV- or HBV-infected patients without HIV coinfection: proteinuria 12.4  to 27.3%  and haematuria 9% [122,123] in HCV- infected patients; proteinuria 17%  to 30%  and haematuria 30%  in HBV-infected patients.
HCV-associated cryoglobulinaemic glomerulonephritis has been well described in both HIV-coinfected and uninfected patients and is characterized by membranoproliferative glomerulonephritis, purpura, arthralgias and peripheral neuropathy [126,127]. The renal presentation of HCV in HIV/HCV coinfected patients may include renal insufficiency, proteinuria, haematuria, depressed complement levels, and circulating cryoglobulins. The course of HCV-associated renal disease is much more aggressive in the HIV-coinfected patient, with some progressing to ESRD in a matter of months [127,128]. However, while previous reports had shown associations between HIV and coinfection with HCV, Dezzutti et al.  did not find an association between HIV infection and cryoglobulinaemia.
In patients not coinfected with HIV, the association of membranous nephropathy with HBV, malignancy and syphilis has also been well described, and the reports of membranous nephropathy in HIV-infected patients may be explained by the high incidence of HBV infection, malignancies and syphilis in this population [129–135].
Renal functions need to be monitored in patients with HIV/AIDS and potentially reversible factors need to be identified and managed. Adapting the Expert Guidelines Recommendations , we suggest 10 points concerning the antiretroviral drug use and kidney disease management in HIV-infected patients.
The authors thank Sandra Campin and Dr Colin Campin for their technical assistance.
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