- Renal Unit and Renal Transplant Unit, Statewide Renal Service, Royal Prince Alfred Hospital, Camperdown, NSW
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW
Last reviewed: November 2019
Renal disease has emerged as one of the predominant non-infectious comorbidities (NICMs) seen among people with human immunodeficiency virus (HIV) infection1,2. It has long been recognised that people with HIV infection are at particular risk of renal disease, although the pattern of disease has changed significantly over time. Rather than the previously seen HIV-related renal disorders, such as HIV-associated nephropathy (HIVAN)3, the chronic kidney disease (CKD) now seen often relates to sequelae of chronic NICMs, such as diabetes and hypertension4. In addition, the widespread use of antiretroviral therapy (ART) and improved patient survival has resulted in ageing of the patient cohort and increased exposure to potentially nephrotoxic medications, including antiretroviral drugs5. Consequently, in the era of modern ART, the burden of renal disease has increased, despite a reduction in renal diseases caused directly by HIV infection. The increased prevalence of CKD in this patient group has led to an emerging focus on delivering models of care for multiple NICMs efficiently and effectively, as well as concerns regarding polypharmacy and geriatric-specific considerations6. In addition, the recognition of a genetic predisposition to kidney disease in this patient group is important, with some patients still at risk of HIV-induced renal disease, particularly those patients of sub-Saharan African origin7.
Renal disease is important in this patient group because the presence of CKD is associated with increased rates of morbidity and mortality8. Increasing numbers of HIV-infected patients are observed with CKD, as well as increasing numbers of HIV-infected patients requiring dialysis or kidney transplantation9. Early detection of renal disease and effective screening and management of risk factors for renal disease in HIV-infected people may help reduce the current burden of CKD10.