Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Curr Opin Nephrol Hypertens. 2018 May;27(3):144-152. doi: 10.1097/MNH.0000000000000400.
Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) was identified as the major renal manifestation of HIV infection early in the HIV epidemic. However, HIV infection now is associated with a different spectrum of renal lesions leading to chronic kidney disease. This review examines the changes in kidney injury occurring in the current HIV era and the factors involved in this transformation of disease expression.
The incidence of HIVAN and opportunistic infections in HIV-infected individuals has declined in concert with the use of effective combination antiretroviral agents. Chronic kidney disease has become more prevalent as patients infected with HIV are living longer and developing non-HIV-associated diseases such as hypertension and diabetes. Additionally, noncollapsing focal and segmental glomerulosclerosis, co-infection with hepatitis C, HIV-associated immune complex kidney disease, HIV-related accelerated aging, and antiretroviral therapies contribute to progressive loss of renal function.
HIV infection is now associated with a variety of renal lesions causing chronic kidney disease, not all of which are virally induced. It is important to determine the cause of renal functional decline in an HIV-infected patient, as this will impact patient management and prognosis.
人类免疫缺陷病毒（HIV）相关性肾病（HIVAN）是 HIV 感染早期 HIV 感染的主要肾脏表现。然而，HIV 感染现在与导致慢性肾脏病的不同肾脏病变有关。本综述探讨了当前 HIV 时代发生的肾脏损伤变化以及导致疾病表现转变的相关因素。
随着有效的联合抗逆转录病毒药物的使用，HIV 感染者中 HIVAN 和机会性感染的发生率有所下降。慢性肾脏病的发病率越来越高，因为感染 HIV 的患者寿命延长，并且患上了非 HIV 相关的疾病，如高血压和糖尿病。此外，非塌陷性局灶节段性肾小球硬化、丙型肝炎合并感染、HIV 相关免疫复合物性肾病、HIV 相关加速老化以及抗逆转录病毒治疗都会导致肾功能逐渐丧失。
HIV 感染现在与多种导致慢性肾脏病的肾脏病变有关，并非所有病变都是病毒诱导的。确定 HIV 感染患者肾功能下降的原因很重要，因为这将影响患者的治疗和预后。
