Comment: HIV Medicine Association of IDSA clinical practice guidelines detail diagnostics for evaluation of HIV-related chronic kidney disease. Routine screening includes eGFR by CKD-EPI creatinine equation or the Cockcroft-Gault equation and urinalysis or quantitative measure of albuminuria/proteinuria. In those patients with GFR < 60, avoidance of tenofovir recommended.
Comment: Based on VA data of 21,590 HIV+ men, authors developed CKD risk score to predict absolute 5-year risk of developing CKD, defined as two consecutive measurements of eGFR < 60 at least 3 months apart and not obtained during inpatient admissions. Risk factors included: age, glucose >140, SBP >140, HTN, TG >200, proteinuria >30mg/dl, and CD4 < 200. After controlling for risk factors via risk score, overall RR of CKD was two-fold higher in TDF ever vs never users.
Comment: Nested case-control study of 751 HIV+ patients followed 1996-2010 found HIVICK assocaited with VL >400 (OR, 3.0; 95%CI, 1.2-5.2), diabetes (OR, 2.8; 95%CI, 1.1-6.8), and hypertension (OR, 2.3; 95%CI, 1.2-4.5). Compared with HIVAN, pts with HIVICK had more ART exposure, lower VL, and higher CD4 and eGFR. ESRD was less common in HIVICK vs HIVAN (30% vs 82%; P< 0.001).
Comment: NA-ACCORD study of 93,495 HIV+ people in US and Canada compared CKD incidence in HCV seronegative, HCV viremic, and HCV aviremic participants. HCV seropositive pts with or without viremia were at increased risk for CKD.
Comment: Analytical review supports ART to treat HIVAN with evidence to support improvement in kidney function associated with VL suppression. Adjunct treatment includes avoidance of nephrotoxins, routine measurement of eGFR, and assessment for proteinuria.
Comment: Epidemiology-focused review of HIVAN notes contribution of both host genetic attributes, e.g., APOL1 and MYH9 alleles, and pathogenicity of HIV. ART initation indicated to improve kidney function. Renal transplant is an alternative to dialysis in well-controlled HIV infection.
Comment: Review covers pathology of HIVAN with detailed discussion of human and mouse genetic studies.
Comment: Reduced rates of HIVAN, due to increased numbers of HIV+ pts on ART, expose hypertension and diabetes as cause of chronic kidney disease.
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