Naicker Saraladevi
Clin Nephrol. 2020 Supplement-Jan;93(1):87-93. doi: 10.5414/CNP92S115.
Chronic kidney disease (CKD) is a frequent complication of HIV infection. The classic involvement of the kidney by HIV infection is HIV-associated nephropathy (HIVAN), occurring typically in young adults of African ancestry with advanced HIV disease in association with high-risk variants. HIV-immune complex disease is histologically the second most common diagnosis. With the introduction of antiretroviral therapy (ART), there has been a decline in the incidence of HIVAN, with an increasing prevalence of focal segmental glomerulosclerosis. Several studies have demonstrated overall improvement in kidney function with initiation of ART. Many antiretroviral medications are partially or completely eliminated by the kidney and require dose adjustment in CKD. HIV-positive patients requiring either hemo- or peritoneal dialysis, who are stable on ART, are achieving survival rates comparable to those of dialysis patients without HIV infection. Kidney transplantation has been performed successfully in HIV-positive patients; graft and patient survival is similar to that of HIV-negative recipients. Early detection of kidney disease by implementation of screening on diagnosis of HIV infection and annual screening thereafter will have an impact on the burden of disease, together with access to ART. Programs for prevention of HIV infection are essential.
慢性肾脏病（CKD）是HIV感染的常见并发症。HIV感染对肾脏的典型累及是HIV相关性肾病（HIVAN），通常发生在非洲裔年轻成年人中，这些人患有晚期HIV疾病且伴有高风险变异。HIV免疫复合物疾病在组织学上是第二常见的诊断。随着抗逆转录病毒疗法（ART）的引入，HIVAN的发病率有所下降，局灶节段性肾小球硬化的患病率则不断上升。多项研究表明，开始ART后肾功能总体有所改善。许多抗逆转录病毒药物会被肾脏部分或完全清除，在CKD患者中需要调整剂量。接受血液透析或腹膜透析且ART治疗稳定的HIV阳性患者，其生存率与未感染HIV的透析患者相当。HIV阳性患者已成功进行肾脏移植；移植肾和患者的生存率与HIV阴性受者相似。通过在诊断HIV感染时进行筛查并在此后每年进行筛查来早期发现肾脏疾病，连同获得ART治疗一起，将对疾病负担产生影响。预防HIV感染的项目至关重要。
