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Changing concepts of HIV infection and renal disease

Hou, Jean; Nast, Cynthia, C.

Current Opinion in Nephrology and Hypertension: May 2018 - Volume 27 - Issue 3 - p 144–152
doi: 10.1097/MNH.0000000000000400

Purpose of review Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) was identified as the major renal manifestation of HIV infection early in the HIV epidemic. However, HIV infection now is associated with a different spectrum of renal lesions leading to chronic kidney disease. This review examines the changes in kidney injury occurring in the current HIV era and the factors involved in this transformation of disease expression.

Recent findings The incidence of HIVAN and opportunistic infections in HIV-infected individuals has declined in concert with the use of effective combination antiretroviral agents. Chronic kidney disease has become more prevalent as patients infected with HIV are living longer and developing non-HIV-associated diseases such as hypertension and diabetes. Additionally, noncollapsing focal and segmental glomerulosclerosis, co-infection with hepatitis C, HIV-associated immune complex kidney disease, HIV-related accelerated aging, and antiretroviral therapies contribute to progressive loss of renal function.

Summary HIV infection is now associated with a variety of renal lesions causing chronic kidney disease, not all of which are virally induced. It is important to determine the cause of renal functional decline in an HIV-infected patient, as this will impact patient management and prognosis.

Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA

Correspondence to Cynthia C. Nast, MD, Department of Pathology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. Tel: +1 310 423 6658; fax: +1 310 423 5881; e-mail:

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