HIV associated nephropathy natural history, complications and prognosis: Difference between revisions
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* 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: | |||
**Low CD4 count | |||
**High viral load | |||
**Proteinuria (high-grade) | |||
**APOL1 polymorphism | |||
**Comorbidities (hypertension and diabetes) | |||
'''The following are favorable prognostic factors:''' | '''<s>The following are favorable prognostic factors:</s>''' | ||
* Patients on HAART therapy | *<s>Patients on HAART therapy</s> | ||
* Patients with low-grade proteinuria | *<s>Patients with low-grade proteinuria</s> | ||
* Patients who have a suppressed HIV-1 viral load | *<s>Patients who have a suppressed HIV-1 viral load</s> | ||
* Patients who express a normal renal echogenicity | *<s>Patients who express a normal renal echogenicity</s> | ||
* Patients with CD4 levels that between 200 and 500 cells/mm<sup>3</sup> | *<s>Patients with CD4 levels that between 200 and 500 cells/mm<sup>3</sup></s> | ||
* Patients who have higher estimated glomerular filtration rates | *<s>Patients who have higher estimated glomerular filtration rates</s> | ||
'''The following are poor prognostics factors:''' | |||
* Patients not receiving HAART therapy | '''<s>The following are poor prognostics factors:</s>''' | ||
* Patients with high-grade proteinuria | *<s>Patients not receiving HAART therapy</s> | ||
* Patients who have under suppressed HIV-1 viral load | *<s>Patients with high-grade proteinuria</s> | ||
* Patients who express a large renal echogenicity | *<s>Patients who have under suppressed HIV-1 viral load</s> | ||
* Patients who have CD4 levels that are below 200 cells/mm<sup>3</sup> | *<s>Patients who express a large renal echogenicity</s> | ||
* Patients who have lower estimated glomerular filtration rates | *<s>Patients who have CD4 levels that are below 200 cells/mm<sup>3</sup></s> | ||
*<s>Patients who have lower estimated glomerular filtration rates</s> | |||
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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]Shakiba Hassanzadeh, MD[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:
- End-stage renal disease (ESRD)[1]
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.18190325
- 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.[2]
- Several factors have been associated with increased risk of progression of kidney disease in patients with HIVAN, which include:
- Low CD4 count
- High viral load
- Proteinuria (high-grade)
- APOL1 polymorphism
- Comorbidities (hypertension and diabetes)
The following are favorable prognostic factors:
Patients on HAART therapyPatients with low-grade proteinuriaPatients who have a suppressed HIV-1 viral loadPatients who express a normal renal echogenicityPatients with CD4 levels that between 200 and 500 cells/mm3Patients who have higher estimated glomerular filtration rates
The following are poor prognostics factors:
Patients not receiving HAART therapyPatients with high-grade proteinuriaPatients who have under suppressed HIV-1 viral loadPatients who express a large renal echogenicityPatients who have CD4 levels that are below 200 cells/mm3Patients who have lower estimated glomerular filtration rates
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, 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.