Department of Physiology and Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Semin Nephrol. 2023 Sep;43(5):151470. doi: 10.1016/j.semnephrol.2023.151470. Epub 2024 Jan 20.
Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading infectious causes of death globally. The combined brunt of these diseases is experienced mainly in low-income and lower-middle-income countries. HIV/TB have devastating effects on the kidneys, leading to accelerated decline of kidney function as well as mortality. Managing the triad of TB/HIV and kidney disease is challenging. We discuss the epidemiology of HIV/TB coinfection and the kidney and the key mechanisms of kidney disease including genetic susceptibility. The clinical presentation and pathology, as well as the challenges of diagnosing CKD in these patients, also are discussed. The strategies to prevent and manage HIV/TB-related kidney disease such as proper assessment, avoiding nephrotoxic regimens, drug dose adjustments, kidney function monitoring, avoidance of drug-drug interactions, and other interventions are explored. We also briefly discuss the complexities around HIV/TB patients on dialysis and kidney transplantation. HIV/TB coinfection presents an increased risk for kidney-related morbidity and mortality; patients with this triad need to be given special consideration for future research and management.
人类免疫缺陷病毒 (HIV) 和结核病 (TB) 是全球主要的传染病死因。这些疾病的综合影响主要发生在低收入和中低收入国家。HIV/TB 对肾脏有毁灭性影响，导致肾功能加速下降和死亡率增加。管理 TB/HIV 和肾脏疾病的三联症具有挑战性。我们讨论了 HIV/TB 合并感染和肾脏的流行病学，以及包括遗传易感性在内的肾脏疾病的关键机制。还讨论了这些患者中 CKD 的临床表现和病理学以及诊断的挑战。探讨了预防和管理 HIV/TB 相关肾脏疾病的策略，如适当评估、避免肾毒性方案、药物剂量调整、肾功能监测、避免药物相互作用以及其他干预措施。我们还简要讨论了接受透析和肾移植的 HIV/TB 患者的复杂性。HIV/TB 合并感染增加了肾脏相关发病率和死亡率的风险；需要特别考虑对这些三联症患者进行未来的研究和管理。
