Treatment of renal disease in people with HIV infection

CKD has important implications for clinical outcomes, with a higher burden of morbidity and mortality. It is associated particularly with ESRD and a high burden of cardiovascular disease37. Patients with HIV infection and renal impairment in the presence of albuminuria are at particular risk of increased morbidity and mortality54. These patients should be closely assessed for reversible factors placing them at risk of progression of renal disease; these risk factors should be addressed early. Attention to blood pressure control, treatment of hyperglycaemia, hyperlipidaemia and lifestyle factors, such as weight loss and smoking cessation, are important considerations. As well, pharmacological control of hypertension with an ACE-inhibitor or an ARB should be commenced, particularly if there is proteinuria at baseline37. Other reversible causes for renal impairment should be sought, such as the use of nephrotoxic medications, and underlying renal conditions such as HIVAN should be excluded. Patients with HIVAN should be placed on ART if they are not receiving it already32. Patients with CKD or ESRD should also be commenced on ART, as this is associated with better outcomes in this patient group. Dose adjustment of medications excreted by the kidneys should also be undertaken, and the use of potentially nephrotoxic agents should be avoided29. The management of patients with HIV infection who have established renal impairment is usually undertaken in conjunction with a Nephrologist29,30,37.