Department of Pathology, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Baltimore, MD 21287, USA.
School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa.
Nat Rev Nephrol. 2015 Mar;11(3):150-60. doi: 10.1038/nrneph.2015.9. Epub 2015 Feb 17.
HIV is a highly adaptive, rapidly evolving virus, which is associated with renal diseases including collapsing glomerulopathy-the classic histomorphological form of HIV-associated nephropathy. Other nephropathies related to viral factors include HIV-immune-complex kidney disease and thrombotic microangiopathy. The distribution of HIV-associated kidney diseases has changed over time and continues to vary across geographic regions worldwide. The reasons for this diversity are complex and include a critical role of APOL1 variants and possibly other genetic factors, disparities in access to effective antiviral therapies, and likely other factors that we do not yet fully understand. The mechanisms responsible for HIVAN, including HIV infection of podocytes and tubular epithelial cells, the molecules responsible for HIV entry, and diverse mechanisms of cell injury, have been the focus of much study. Although combined antiretroviral therapy is effective at preventing and reversing HIVAN, focal segmental glomerulosclerosis, arterionephrosclerosis and diabetic nephropathy are increasingly common in individuals who have received such therapy for many years. These diseases are associated with metabolic syndrome, obesity and premature ageing. Future directions for HIV-related kidney disease will involve regular screening for drug nephrotoxicity and incipient renal disease, as well as further research into the mechanisms by which chronic inflammation can lead to glomerular disease.
HIV 是一种高度适应、快速进化的病毒，与包括塌陷性肾小球病在内的肾脏疾病相关——这是 HIV 相关性肾病的经典组织形态学形式。与病毒因素相关的其他肾病包括 HIV 免疫复合物肾病和血栓性微血管病。HIV 相关性肾病的分布随时间而变化，并且在全球不同地区继续存在差异。这种多样性的原因很复杂，包括 APOL1 变异体的关键作用和可能的其他遗传因素、获得有效抗病毒治疗的差异，以及我们尚未完全理解的可能其他因素。HIVAN 的发病机制，包括 HIV 对足细胞和肾小管上皮细胞的感染、负责 HIV 进入的分子以及细胞损伤的多种机制，一直是许多研究的重点。尽管联合抗逆转录病毒疗法可有效预防和逆转 HIVAN，但在接受多年此类治疗的患者中，局灶节段性肾小球硬化症、动脉硬化性肾病和糖尿病肾病越来越常见。这些疾病与代谢综合征、肥胖和过早衰老有关。HIV 相关性肾病的未来方向将涉及定期筛查药物肾毒性和早期肾脏疾病，以及进一步研究慢性炎症如何导致肾小球疾病的机制。
