A wide clinical spectrum of renal diseases affects individuals with HIV. These conditions include acute kidney injury, electrolyte and acid–base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and adverse side effects related to treatment of HIV. Studies employing varying criteria for diagnosis of kidney disease have reported a variable prevalence of these diseases in patients with HIV in sub-Saharan Africa: 6% in South Africa, 38% in Nigeria, 26% in Côte d'Ivoire, 28% in Tanzania, 25% in Kenya, 20–48.5% in Uganda and 33.5% in Zambia. Results from these studies also suggest that a broader spectrum of histopathological lesions in HIV-associated kidney disease exists in African populations than previously thought. Strategies to prevent or retard progression to end-stage renal disease of HIV-associated kidney conditions should include urinalysis and measurement of kidney function of all people with HIV at presentation. Renal replacement in the form of dialysis and transplantation should be implemented as appropriate. This Review focuses on the available evidence of renal diseases in patients with HIV infection in sub-Saharan Africa and offers practical guidelines to treat these conditions that also take into consideration challenges and obstacles that are specific to sub-Saharan Africa.
A prevalence ranging between 6% and 48% of chronic kidney disease has been reported among patients with HIV in sub-Saharan Africa
The spectrum of kidney disease includes acute kidney injury, electrolyte and acid–base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and adverse side effects of HIV treatment
Inadequate access to antiretroviral therapy could influence the prevalence and pattern of kidney disease observed in patients with HIV in sub-Saharan Africa
Renal replacement therapy is not as easily accessible to patients with HIV in sub-Saharan Africa as it is to their counterparts in developed countries
Screening, early diagnosis and early therapy for kidney disease is recommended for all patients with HIV
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Apetrei, C., Marx, P. A. & Smith, S. M. The evolution of HIV and its consequences. Infect. Dis. Clin. North Am. 18, 369–394 (2004).
Krogstad, P. Molecular biology of the human immunodeficiency virus: current and future targets for intervention. Semin. Pediatr. Infect. Dis. 14, 258–268 (2003).
UNAIDS The Joint United Nations Programme on HIV/AIDS. UNAIDS/WHO “AIDS Epidemic Update: December 2007” (2007).
Pardo, V. et al. Glomerular lesions in the acquired immunodeficiency syndrome. Ann. Intern. Med. 101, 429–434 (1984).
Mazbar, S. A., Schoenfeld, P. Y. & Humphreys, M. H. Renal involvement in patients infected with HIV: experience at San Francisco General Hospital. Kidney Int. 37, 1325–1332 (1990).
Rao, T. K. et al. Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome. N. Engl. J. Med. 310, 669–673 (1984).
Pardo, V. et al. AIDS-related glomerulopathy: occurrence in specific risk groups. Kidney Int. 31, 1167–1173 (1987).
Cohen, A. H. & Nast, C. C. HIV-associated nephropathy. A unique combined glomerular, tubular, and interstitial lesion. Mod. Pathol. 1, 87–97 (1988).
Klotman, P. E. HIV-associated nephropathy. Kidney Int. 56, 1161–1176 (1999).
Strauss, J. et al. Renal disease in children with the acquired immunodeficiency syndrome. N. Engl. J. Med. 321, 625–630 (1989).
Levin, M. L. et al. HIV-associated nephropathy occurring before HIV antibody seroconversion. Am. J. Kidney Dis. 37, E39 (2001).
Mocroft, A. et al. Chronic renal failure among HIV-1-infected patients. AIDS 21, 1119–1127 (2007).
Cheung, C. Y. et al. Prevalence of chronic kidney disease in Chinese HIV-infected patients. Nephrol. Dial. Transplant. 22, 3186–3190 (2007).
Cavalcante, M. A., Coelho, S. N. & Lacerda, H. R. Prevalence of persistent proteinuria in stable HIV/AIDS patients and its association with HIV nephropathy. Braz. J. Infect. Dis. 11, 456–461 (2007).
Hailemariam, S. et al. Renal pathology and premortem clinical presentation of Caucasian patients with AIDS: an autopsy study from the era prior to antiretroviral therapy. Swiss Med. Wkly 131, 412–417 (2001).
Janakiraman, H. et al. Correlation of CD4 counts with renal disease in HIV positive patients. Saudi J. Kidney Dis. Transpl. 19, 603–607 (2008).
Frequency of proteinuria among HIV-infected patients. European Society of Clinical Microbiology and Infectious Diseases; 31 Mar–04 April; ICC, Munich, Germany (2007).
Freedman, B. I., Soucie, J. M., Stone, S. M. & Pegram, S. Familial clustering of end-stage renal disease in blacks with HIV-associated nephropathy. Am. J. Kidney Dis. 34, 254–258 (1999).
Laradi, A., Mallet, A., Beaufils, H., Allouache, M. & Martinez, F. HIV-associated nephropathy: outcome and prognosis factors. Groupe d' Etudes Nephrologiques d'Ile de France. J. Am. Soc. Nephrol. 9, 2327–2335 (1998).
Kopp, J. B. & Winkler, C. HIV-associated nephropathy in African Americans. Kidney Int. Suppl. 83, S43–S49 (2003).
Bourgoignie, J. J. Renal complications of human immunodeficiency virus type 1. Kidney Int. 37, 1571–1584 (1990).
Winston, J. A. & Klotman, P. E. Are we missing an epidemic of HIV-associated nephropathy? J. Am. Soc. Nephrol. 7, 1–7 (1996).
Rao, T. K. Human immunodeficiency virus infection and renal failure. Infect. Dis. Clin. North Am. 15, 833–850 (2001).
Ross, M. J. & Klotman, P. E. Recent progress in HIV-associated nephropathy. J. Am. Soc. Nephrol. 13, 2997–3004 (2002).
USRDS United States Renal Data System. Annual Data Report; Chapter 2–End Stage Renal Disease (ESRD) Incidence and Prevalence 2007 (2007).
Williams, D. I. et al. Presentation, pathology, and outcome of HIV associated renal disease in a specialist centre for HIV/AIDS. Sex. Transm. Infect. 74, 179–184 (1998).
Lameire, N., Van Biesen, W. & Vanholder, R. The changing epidemiology of acute renal failure. Nat. Clin. Pract. Nephrol. 2, 364–377 (2006).
D'Agati, V. & Appel, G. B. HIV infection and the kidney. J. Am. Soc. Nephrol. 8, 138–152 (1997).
Roling, J., Schmid, H., Fischereder, M., Draenert, R. & Goebel, F. D. HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy. Clin. Infect. Dis. 42, 1488–1495 (2006).
Kimmel, P. L. The nephropathies of HIV infection: pathogenesis and treatment. Curr. Opin. Nephrol. Hypertens. 9, 117–122 (2000).
Peraldi, M. N. et al. Acute renal failure in the course of HIV infection: a single-institution retrospective study of ninety-two patients and sixty renal biopsies. Nephrol. Dial. Transplant. 14, 1578–1585 (1999).
Franceschini, N., Napravnik, S., Finn, W. F., Szczech, L. A. & Eron, J. J. Jr. Immunosuppression, hepatitis C infection, and acute renal failure in HIV-infected patients. J. Acquir. Immune Defic. Syndr. 42, 368–372 (2006).
Han, T. M., Naicker, S., Ramdial, P. K. & Assounga, A. G. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa. Kidney Int. 69, 2243–2250 (2006).
Fabian, J. et al. Urinary screening abnormalities in antiretroviral-naïve HIV-infected outpatients and implications for management—a single-centre study in South Africa. Ethn. Dis. 19 (Suppl. 1), 80–85 (2009).
Gerntholtz, T. E., Goetsch, S. J. & Katz, I. HIV-related nephropathy: a South African perspective. Kidney Int. 69, 1885–1891 (2006).
Emem, C. P. et al. Renal disease in HIV-seropositive patients in Nigeria: an assessment of prevalence, clinical features and risk factors. Nephrol. Dial. Transplant. 23, 741–746 (2008).
Mortier, E., Toure, S., Seyler, C., Bloch, M. & Anglaret, X. Urinary pH in HIV-infected adults in Ivory Coast and in France. AIDS 17, 2003–2005 (2003).
Janabi, M. Y. et al. Renal abnormalities associated with human immunodeficiency virus infection among police officers in Dar-es-Salaam, Tanzania. XIV International AIDS Conference, July 7–12; Barcelona, Spain (2002).
Wools-Kaloustian, K. et al. Renal disease in an antiretroviral-naive HIV-infected outpatient population in Western Kenya. Nephrol. Dial. Transplant. 22, 2208–2212 (2007).
Andia, I., Pepper, L. M. & Matthieson, P. Prevalence of renal disease in outpatients with HIV/AIDS in Mbarara Hospital. 3rd IAS (International Aids Society) Conference on HIV Pathogenesis and Treatment. Rio de Janeiro, (2005).
Peters, P. J. et al. Antiretroviral therapy improves renal function among HIV-infected Ugandans. Kidney Int. 74, 925–929 (2008).
Mulenga, L. B. et al. Baseline renal insufficiency and risk of death among HIV-infected adults on antiretroviral therapy in Lusaka, Zambia. AIDS 22, 1821–1827 (2008).
Gardner, L. I. et al. Development of proteinuria or elevated serum creatinine and mortality in HIV-infected women. J. Acquir. Immune Defic. Syndr. 32, 203–209 (2003).
World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children (2007).
Gupta, S. K. et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin. Infect. Dis. 40, 1559–1585 (2005).
Ahuja, T. S., Collinge, N., Grady, J. & Khan, S. Is dialysis modality a factor in survival of patients with ESRD and HIV-associated nephropathy? Am. J. Kidney Dis. 41, 1060–1064 (2003).
Soleymanian, T. et al. Survival and morbidity of HIV patients on hemodialysis and peritoneal dialysis: one center's experience and review of the literature. Int. Urol. Nephrol. 38, 331–338 (2006).
Wall, S. D., Howe, J. M. & Sawhney, R. Human deficiency virus infection and hepatitis: biosafety in radiology. Radiology 205, 619–628 (1997).
Obialo, C. I., Hewan-Lowe, K. & Fulong, B. Nephrotic proteinuria as a result of essential hypertension. Kidney Blood Press. Res. 25, 250–254 (2002).
Curi, M. A. et al. Hemodialysis access: influence of the human immunodeficiency virus on patency and infection rates. J. Vasc. Surg. 29, 608–616 (1999).
Sullivan, P. S., Hanson, D. L., Chu, S. Y., Jones, J. L. & Ward, J. W. Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 91, 301–308 (1998).
Moore, R. D., Keruly, J. C. & Chaisson, R. E. Anemia and survival in HIV infection. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 19, 29–33 (1998).
Shrivastava, D. et al. The efficacy of erythropoietin in human immunodeficiency virus-infected end-stage renal disease patients treated by maintenance hemodialysis. Am. J. Kidney Dis. 25, 904–909 (1995).
Nelson, R. G. & Tuttle, K. R. The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD. Blood Purif. 25, 112–114 (2007).
Farzadegan, H., Ford, D., Malan, M., Masters, B. & Scheel, P. J. Jr. HIV-1 survival kinetics in peritoneal dialysis effluent. Kidney Int. 50, 1659–1662 (1996).
Ragni, M. V. et al. Survival of human immunodeficiency virus-infected liver transplant recipients. J. Infect. Dis. 188, 1412–1420 (2003).
Roland, M. E. & Stock, P. G. Review of solid-organ transplantation in HIV-infected patients. Transplantation 75, 425–429 (2003).
Stock, P. G. et al. Kidney and liver transplantation in human immunodeficiency virus-infected patients: a pilot safety and efficacy study. Transplantation 76, 370–375 (2003).
Venter, F. et al. Uniquely South African: Time to consider offering HIV-positive donor kidneys to HIV-infected renal failure patients. SAMJ 98, 182–183 (2008).
Beresford, B. SA pioneers HIV + transplant. Mail & Guardian [online], (2008).
Berns, J. S. & Kasbekar, N. Highly active antiretroviral therapy and the kidney: an update on antiretroviral medications for nephrologists. Clin. J. Am. Soc. Nephrol. 1, 117–129 (2006).
Izzedine, H., Launay-Vacher, V., Baumelou, A. & Deray, G. An appraisal of antiretroviral drugs in hemodialysis. Kidney Int. 60, 821–830 (2001).
Eustace, J. A. et al. Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids. Kidney Int. 58, 1253–1260 (2000).
Kimmel, P. L., Mishkin, G. J. & Umana, W. O. Captopril and renal survival in patients with human immunodeficiency virus nephropathy. Am. J. Kidney Dis. 28, 202–208 (1996).
Burns, G. C., Paul, S. K., Toth, I. R. & Sivak, S. L. Effect of angiotensin-converting enzyme inhibition in HIV-associated nephropathy. J. Am. Soc. Nephrol. 8, 1140–1146 (1997).
Ingulli, E. et al. Nephrotic syndrome associated with acquired immunodeficiency syndrome in children. J. Pediatr. 119, 710–716 (1991).
Betjes, M. G. & Verhagen, D. W. Stable improvement of renal function after initiation of highly active anti-retroviral therapy in patients with HIV-1-associated nephropathy. Nephrol. Dial. Transplant. 17, 1836–1839 (2002).
Chemlal, K., Nochy, D., Kenouch, S., Joly, V. & Carbon, C. Dramatic improvement of renal dysfunction in a human immunodeficiency virus-infected woman treated with highly active antiretroviral therapy. Clin. Infect. Dis. 31, 805–806 (2000).
Kirchner, J. T. Resolution of renal failure after initiation of HAART: 3 cases and a discussion of the literature. AIDS Read. 12, 103–105, 110–112 (2002).
Szczech, L. A. et al. Protease inhibitors are associated with a slowed progression of HIV-related renal diseases. Clin. Nephrol. 57, 336–341 (2002).
World Health Organization UNAIDS Global summary of the AIDS epidemic, December 2007 [online], (2008).
The authors declare no competing financial interests.
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Fabian, J., Naicker, S. HIV and kidney disease in sub-Saharan Africa. Nat Rev Nephrol 5, 591–598 (2009). https://doi.org/10.1038/nrneph.2009.141
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