Renal consequences of HIV and HIV therapy.

PURPOSE OF REVIEW

To highlight the latest data documenting new concerns about renal function in HIV-infected patients, with regard to acute renal failure with its known burden of mortality and prolonged hospitalization, antiretroviral medication errors potentially enhancing the risk of the emergence of viral resistance, outcome of HIV dialysis patients, and renal involvement in the immune restoration inflammatory syndrome.

RECENT FINDINGS

The incidence of acute renal failure in HIV-infected patients is increasing, secondary to ageing, chronic kidney disease and liver disease. Histological documentation is critical for the best diagnosis. Antiretroviral medication errors are very frequently encountered in HIV-infected patients, which may be associated with decreased survival as a result of the under/over-prescription of highly active antiretroviral therapy in chronic kidney disease or end-stage renal disease.

SUMMARY

Evaluating the glomerular filtration rate with plasma creatinine and one of the validated formulae is critical in HIV-infected patients to determine the optimum follow-up strategy and critical therapeutic measures, such as drug dosage adaptation. High-risk radiological diagnostic procedures or potentially nephrotoxic drugs should be used with caution. These measures should reduce the rate of progression of chronic kidney disease. Increasing numbers of dialysed HIV-infected patients emphasize the need for the better coordination of care.