HIV-associated nephropathy: A brief review

HIV-associated nephropathy (HIVAN) is an important cause of renal failure in HIV-1 seropositive patients. The disease is characterized by collapsing focal segmental glomerulosclerosis with marked podocyte proliferation, microcystic dilatation of the tubules and interstitial nephritis. Patients generally present with advanced HIV-1 infection, renal insufficiency and marked proteinuria. No serologic markers exist to diagnose HIVAN, and given the broad differential diagnosis for renal failure in these patients, renal biopsy should be performed. Viral infection of renal cells plays a central role in the pathogenesis of HIVAN. There is now compelling evidence that highly active antiretroviral therapy (HAART) is effective in preventing end-stage renal disease in patients affected with HIVAN. The efficacy of angiotensin-converting enzyme (ACE) inhibitors and prednisone has also been evaluated, but larger prospective studies are needed.