HIV associated nephropathy medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2];Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3]
Overview
Medical Therapy
ACE Inhibitors
The use of an ACE inhibitor such as Fosinopril has been linked to higher renal survival before progression to end-stage renal disease. The effects where studied in a prospective non-randomized trial between 1993 and 1995. The study showed that the use of an ACE inhibitor decreased the rate patients with HIV-associated nephropathy of developing end-stage renal disease over 5 years. In another retrospective study, the use of captopril with a reverse transcriptase inhibitor prolonged renal survival time by about 156 days when compared to those who were not taking an ACE inhibitor (37 days).
HAART
With the advent of HAART therapy the renal survival time in patients with HIV-associated nephropathy has greatly slowed the progression to end-stage renal disease. In a case-control study, the use of antiretroviral therapy for a span of 56 days, has been shown to have a protective effect on the renal. In a another retrospective cohort trial, the use of antiretroviral therapy has showed a survival rate of 18.4 months.[1]
Corticosteroids
- On renal biopsy of patients with HIV associated nephropathy (HIVAN) there is significant tubulointerstitial inflammation, which has been shown to decrease after steroid treatment.
- In a retrospective cohort study, an association was reported between treatment with corticosteroids and the preservation of renal function in HIVAN patients.
- In another retrospective study, reported that corticosteroids delay the progression of HIVAN to renal insufficiency.
Renal replacement with dialysis
- All patients with HIVAN that have progressed to end stage renal disease (ESRD) should go through renal replacement with dialysis.[2]
- The rates of HIVAN progressing to ESRD increased between 1989 to 2006, but has declined since then to 2011.[3]
- There is no need to isolate HIV positive patients in the dialysis center unlike in infection with hepatitis B.[2]
- Predictors of poor survival for patients with HIVAN and on dialysis are:[4]
References
- ↑ Atta MG, Gallant JE, Rahman MH, Nagajothi N, Racusen LC, Scheel PJ; et al. (2006). "Antiretroviral therapy in the treatment of HIV-associated nephropathy". Nephrol Dial Transplant. 21 (10): 2809–13. doi:10.1093/ndt/gfl337. PMID 16864598.
- ↑ 2.0 2.1 Menez S, Hanouneh M, McMahon BA, Fine DM, Atta MG (2018). "Pharmacotherapy and treatment options for HIV-associated nephropathy". Expert Opin Pharmacother. 19 (1): 39–48. doi:10.1080/14656566.2017.1416099. PMC 6381591. PMID 29224373.
- ↑ Razzak Chaudhary S, Workeneh BT, Montez-Rath ME, Zolopa AR, Klotman PE, Winkelmayer WC (2015). "Trends in the outcomes of end-stage renal disease secondary to human immunodeficiency virus-associated nephropathy". Nephrol Dial Transplant. 30 (10): 1734–40. doi:10.1093/ndt/gfv207. PMC 4829059. PMID 26175146.
- ↑ Atta MG, Fine DM, Kirk GD, Mehta SH, Moore RD, Lucas GM (2007). "Survival during renal replacement therapy among African Americans infected with HIV type 1 in urban Baltimore, Maryland". Clin Infect Dis. 45 (12): 1625–32. doi:10.1086/523728. PMC 4096866. PMID 18190325.