Wyatt Christina M, Klotman Paul E
Division of Nephrology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Am J Med. 2007 Jun;120(6):488-92. doi: 10.1016/j.amjmed.2007.01.025.
With improved survival in the era of antiretroviral therapy, kidney disease has emerged as an important complication of Human Immunodeficiency Virus (HIV) infection and antiretroviral therapy. The classic kidney disease of HIV infection, HIV-associated nephropathy, occurs almost exclusively in patients of African descent. HIV-associated nephropathy is characterized by collapsing focal segmental glomerulosclerosis with associated tubular dilatation and interstitial inflammation, although the histology may be more subtle in patients receiving antiretroviral therapy. Renal epithelial cells are infected by HIV-1, which results in epithelial cell proliferation and induction of local inflammatory pathways. Even with appropriate therapy, the kidney is a reservoir for HIV-1. Although the widespread introduction of antiretroviral therapy has had a beneficial impact on the epidemiology of HIV-associated nephropathy, the burden of kidney disease is likely to increase as a result of antiretroviral toxicity, reduction in competing mortality risks, and the increasing prevalence of HIV-1 infection in patients at risk for kidney disease.
在抗逆转录病毒治疗时代，随着患者生存率的提高，肾脏疾病已成为人类免疫缺陷病毒（HIV）感染及抗逆转录病毒治疗的一种重要并发症。HIV感染的典型肾脏疾病——HIV相关性肾病，几乎仅发生于非洲裔患者。HIV相关性肾病的特征为塌陷型局灶节段性肾小球硬化，伴有肾小管扩张和间质炎症，不过接受抗逆转录病毒治疗患者的组织学表现可能更为隐匿。HIV-1可感染肾上皮细胞，导致上皮细胞增殖并诱导局部炎症途径。即便接受适当治疗，肾脏仍是HIV-1的储存库。尽管抗逆转录病毒治疗的广泛应用对HIV相关性肾病的流行病学产生了有益影响，但由于抗逆转录病毒毒性、竞争性死亡风险降低以及肾病高危患者中HIV-1感染率上升，肾脏疾病负担可能会增加。
