HIV associated nephropathy natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
HIV-associated nephropathy (HIVAN) will progress to end | HIV-associated nephropathy (HIVAN) will progress to [[End stage renal disease|end stage renal disease (ESRD)]] in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome. | ||
==Natural History== | ==Natural History== | ||
* If left untreated, HIV-associated nephropathy (HIVAN) will progress to end | * If left untreated, HIV-associated nephropathy (HIVAN) will progress to [[End stage renal disease|end stage renal disease (ESRD)]] in a few weeks to months.<ref name="pmid18588500">{{cite journal| author=Atta MG, Lucas GM, Fine DM| title=HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management. | journal=Expert Rev Anti Infect Ther | year= 2008 | volume= 6 | issue= 3 | pages= 365-71 | pmid=18588500 | doi=10.1586/14787210.6.3.365 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18588500 }}</ref> | ||
* Treatment with cART has shown 60% reduction in the developement of HIVAN.<ref name="pmid18588500" /> | * Treatment with cART has shown 60% reduction in the developement of HIVAN.<ref name="pmid18588500" /> | ||
* Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.<ref name="pmid18588500" /> | * Treatment with cART has shown 38% slowing in the progression of HIVAN towards [[End stage renal disease|ESRD]].<ref name="pmid18588500" /> | ||
* Early diagnosis and Immediate treatment has shown better outcome.<ref name="pmid18588500" /> | * Early [[diagnosis]] and Immediate treatment has shown better outcome.<ref name="pmid18588500" /> | ||
== Complications == | == Complications == | ||
Possible complications that are associated with HIV-associated nephropathy include: | Possible complications that are associated with HIV-associated nephropathy include: | ||
* End | *[[End stage renal disease|End stage renal disease (ESRD)]] <ref name="pmid18588500" /> | ||
==Prognosis== | ==Prognosis== | ||
* Before the advent of cART therapy, the prognosis of HIV-associated nephropathy was fatal. The mortality rate during this time was 100% within 6 months.<ref name="pmid18588500" /> | * Before the advent of cART therapy, the [[prognosis]] of HIV-associated nephropathy was fatal. The [[mortality rate]] during this time was 100% within 6 months.<ref name="pmid18588500" /> | ||
* Today, the prognosis of HIVAN with the availability of cART therapy still remains grim,<ref name="pmid18588500" /> however, treatment with cART has increased renal survival rate.18190325 | * Today, the [[prognosis]] of HIVAN with the availability of cART therapy still remains grim,<ref name="pmid18588500" /> however, treatment with cART has increased renal [[survival rate]].<ref name="pmid18190325">{{cite journal| author=Atta MG, Fine DM, Kirk GD, Mehta SH, Moore RD, Lucas GM| title=Survival during renal replacement therapy among African Americans infected with HIV type 1 in urban Baltimore, Maryland. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 12 | pages= 1625-32 | pmid=18190325 | doi=10.1086/523728 | pmc=4096866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18190325 }} </ref> | ||
* Early diagnosis and Immediate treatment has shown better outcome.<ref name="pmid18588500" /> | * Early [[diagnosis]] and Immediate treatment has shown better outcome.<ref name="pmid18588500" /> | ||
* Treatment with cART has shown 60% reduction in the developement of HIVAN.<ref name="pmid18588500" /> | * Treatment with cART has shown 60% reduction in the developement of HIVAN.<ref name="pmid18588500" /> | ||
* Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.<ref name="pmid18588500" /> | * Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.<ref name="pmid18588500" /> | ||
* The current first and second year survival rate of HIV-associated nephropathy is estimated to be around 63% and 43% respectively, with the use of HAART therapy.<ref name="pmid16271919">{{cite journal| author=Atta MG, Choi MJ, Longenecker JC, Haymart M, Wu J, Nagajothi N | display-authors=etal| title=Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy. | journal=Am J Med | year= 2005 | volume= 118 | issue= 11 | pages= 1288 | pmid=16271919 | doi=10.1016/j.amjmed.2005.05.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16271919 }} </ref> | * The current first and second year survival rate of HIV-associated nephropathy is estimated to be around 63% and 43% respectively, with the use of HAART therapy.<ref name="pmid16271919">{{cite journal| author=Atta MG, Choi MJ, Longenecker JC, Haymart M, Wu J, Nagajothi N | display-authors=etal| title=Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy. | journal=Am J Med | year= 2005 | volume= 118 | issue= 11 | pages= 1288 | pmid=16271919 | doi=10.1016/j.amjmed.2005.05.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16271919 }} </ref> | ||
*Several factors have been associated with increased risk of progression of kidney disease in patients with HIVAN, which include:<ref name="pmid29872351">{{cite journal| author=Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA | display-authors=etal| title=HIV-associated nephropathy: links, risks and management. | journal=HIV AIDS (Auckl) | year= 2018 | volume= 10 | issue= | pages= 73-81 | pmid=29872351 | doi=10.2147/HIV.S141978 | pmc=5975615 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29872351 }} </ref> | *Several factors have been associated with increased risk of progression of kidney disease in patients with HIVAN, which include:<ref name="pmid29872351">{{cite journal| author=Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA | display-authors=etal| title=HIV-associated nephropathy: links, risks and management. | journal=HIV AIDS (Auckl) | year= 2018 | volume= 10 | issue= | pages= 73-81 | pmid=29872351 | doi=10.2147/HIV.S141978 | pmc=5975615 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29872351 }} </ref> | ||
**Low CD4 count | **Low [[CD4]] count | ||
**High viral load | **High [[viral load]] | ||
**Proteinuria (high-grade) | **[[Proteinuria]] (high-grade) | ||
**APOL1 polymorphism | **[[APOL1]] polymorphism | ||
**Comorbidities (hypertension and diabetes) | **Comorbidities ([[hypertension]] and [[diabetes]]) | ||
==References== | ==References== | ||
Latest revision as of 12:05, 30 June 2020
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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: Shakiba Hassanzadeh, MD[3]Krzysztof Wierzbicki M.D. [4]
Overview
HIV-associated nephropathy (HIVAN) will progress to end stage renal disease (ESRD) in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome.
Natural History
- If left untreated, HIV-associated nephropathy (HIVAN) will progress to end stage renal disease (ESRD) in a few weeks to months.[1]
- Treatment with cART has shown 60% reduction in the developement of HIVAN.[1]
- Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.[1]
- Early diagnosis and Immediate treatment has shown better outcome.[1]
Complications
Possible complications that are associated with HIV-associated nephropathy include:
Prognosis
- Before the advent of cART therapy, the prognosis of HIV-associated nephropathy was fatal. The mortality rate during this time was 100% within 6 months.[1]
- Today, the prognosis of HIVAN with the availability of cART therapy still remains grim,[1] however, treatment with cART has increased renal survival rate.[2]
- Early diagnosis and Immediate treatment has shown better outcome.[1]
- Treatment with cART has shown 60% reduction in the developement of HIVAN.[1]
- Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.[1]
- The current first and second year survival rate of HIV-associated nephropathy is estimated to be around 63% and 43% respectively, with the use of HAART therapy.[3]
- Several factors have been associated with increased risk of progression of kidney disease in patients with HIVAN, which include:[4]
- Low CD4 count
- High viral load
- Proteinuria (high-grade)
- APOL1 polymorphism
- Comorbidities (hypertension and diabetes)
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Atta MG, Lucas GM, Fine DM (2008). "HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management". Expert Rev Anti Infect Ther. 6 (3): 365–71. doi:10.1586/14787210.6.3.365. PMID 18588500.
- ↑ 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.
- ↑ Atta MG, Choi MJ, Longenecker JC, Haymart M, Wu J, Nagajothi N; et al. (2005). "Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy". Am J Med. 118 (11): 1288. doi:10.1016/j.amjmed.2005.05.027. PMID 16271919.
- ↑ Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA; et al. (2018). "HIV-associated nephropathy: links, risks and management". HIV AIDS (Auckl). 10: 73–81. doi:10.2147/HIV.S141978. PMC 5975615. PMID 29872351.