Recent developments in HIV and the kidney.

PURPOSE OF REVIEW

Antiretroviral therapy has been immensely successful in reducing the incidence of opportunistic infections and death after HIV infection. This has resulted in heightened interest in noninfectious comorbidities including kidney disease. This review focuses on recent progress in our understanding of the clinical epidemiology of HIV-associated kidney disease.

RECENT FINDINGS

Acute renal failure in the highly active antiretroviral therapy era is associated with delayed HIV diagnosis. The incidence of acute renal failure rapidly declines in patients who receive HIV care, which includes the provision of highly active antiretroviral therapy to patients with advanced HIV infection. The prevalence of chronic kidney disease among HIV-infected patients is approximately 17%, and chronic kidney disease is associated with older age, advanced HIV infection, metabolic and vascular disease, and use of indinavir and tenofovir. Black patients are at increased risk of progression to end-stage renal disease, particularly if not receiving highly active antiretroviral therapy. Although survival of patients requiring dialysis remains poor, renal transplantation is an increasingly promising treatment modality for HIV-associated end-stage renal disease.

SUMMARY

The various forms of HIV-associated kidney dysfunction are now much better defined. The burden of chronic kidney disease is likely to escalate as a result of increasing life expectancy and ageing of HIV-infected patients.