HIV associated nephropathy natural history, complications and prognosis

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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

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. (41)
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. (43)

The following are favorable prognostic factors:

Patients on HAART therapy
Patients with low-grade proteinuria
Patients who have a suppressed HIV-1 viral load
Patients who express a normal renal echogenicity
Patients with CD4 levels that between 200 and 500 cells/mm³
Patients who have higher estimated glomerular filtration rates

The following are poor prognostics factors:

Patients not receiving HAART therapy
Patients with high-grade proteinuria
Patients who have under suppressed HIV-1 viral load
Patients who express a large renal echogenicity
Patients who have CD4 levels that are below 200 cells/mm³
Patients 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.

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[pmid18588500-1] 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.

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