HIV associated nephropathy medical therapy: Difference between revisions
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{{CMG}}{{APM}};{{AE}}{{KW}} | {{CMG}}{{APM}};{{AE}}{{KW}} | ||
==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
===HAART=== | |||
With the advent of HAART therapy the renal survival time in patients with HIV-associated nephropathy has greatly slowed the progression to end-stage renal disease. In a case-control study, the use of antiretroviral therapy for a span of 56 days, has been shown to have a protective effect on the renal. In a another retrospective cohort trial, the use of antiretroviral therapy has showed a survival rate of 18.4 months.<ref name="pmid16864598">{{cite journal| author=Atta MG, Gallant JE, Rahman MH, Nagajothi N, Racusen LC, Scheel PJ et al.| title=Antiretroviral therapy in the treatment of HIV-associated nephropathy. | journal=Nephrol Dial Transplant | year= 2006 | volume= 21 | issue= 10 | pages= 2809-13 | pmid=16864598 | doi=10.1093/ndt/gfl337 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16864598 }} </ref> | |||
=== Renin–angiotensin–aldosterone system (RAAS) blockade === | |||
* In a study, renal survival was increased in patients treated with captopril compared to controls. | |||
* In another study, longer renal survival was reported in patients treated with fosinopril compared to untreated patients. | |||
* Treatment with [[ACE inhibitor]]/[[Angiotensin II receptor antagonist|ARBs]] in HIV-positive patients is recommended when there is: | |||
** Confirmed or suspected [[Human Immunodeficiency Virus (HIV)|HIV]] associated nephropathy (HIVAN) | |||
** Significant [[albuminuria]] (>30 mg/day in [[Diabetes mellitus|diabetic]] patients and >300 mg/ day in non-diabetic patients) | |||
* ACE inhibitors/ARBs have protective effects in patients with chronic renal disease (CKD) by: | |||
** Decreasing intraglomerular pressure | |||
** Decreasing inflammatory mediators | |||
** Reducting proteinuria | |||
===Corticosteroids=== | ===Corticosteroids=== | ||
*On renal biopsy of patients with | *On renal [[biopsy]] of patients with HIVAN there is significant tubulointerstitial inflammation, which has been shown to decrease after [[steroid]] treatment.<ref name="pmid29872351">{{cite journal| author=Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA | display-authors=etal| title=HIV-associated nephropathy: links, risks and management. | journal=HIV AIDS (Auckl) | year= 2018 | volume= 10 | issue= | pages= 73-81 | pmid=29872351 | doi=10.2147/HIV.S141978 | pmc=5975615 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29872351 }} </ref> | ||
*In a retrospective cohort study, an association was reported between treatment with corticosteroids and the preservation of renal function in HIVAN patients.<ref name="pmid10972688">{{cite journal| author=Eustace JA, Nuermberger E, Choi M, Scheel PJ, Moore R, Briggs WA| title=Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids. | journal=Kidney Int | year= 2000 | volume= 58 | issue= 3 | pages= 1253-60 | pmid=10972688 | doi=10.1046/j.1523-1755.2000.00280.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10972688 }} </ref> | *In a [[retrospective cohort study]], an association was reported between treatment with [[Corticosteroid|corticosteroids]] and the preservation of renal function in HIVAN patients.<ref name="pmid10972688">{{cite journal| author=Eustace JA, Nuermberger E, Choi M, Scheel PJ, Moore R, Briggs WA| title=Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids. | journal=Kidney Int | year= 2000 | volume= 58 | issue= 3 | pages= 1253-60 | pmid=10972688 | doi=10.1046/j.1523-1755.2000.00280.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10972688 }} </ref> | ||
* | *Another [[retrospective]] study, reported that corticosteroids delay the progression of HIVAN to renal insufficiency.<ref name="pmid9848787">{{cite journal| author=Laradi A, Mallet A, Beaufils H, Allouache M, Martinez F| title=HIV-associated nephropathy: outcome and prognosis factors. Groupe d' Etudes Néphrologiques d'Ile de France. | journal=J Am Soc Nephrol | year= 1998 | volume= 9 | issue= 12 | pages= 2327-35 | pmid=9848787 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9848787 }} </ref> | ||
=== Renal replacement with dialysis === | === Renal replacement with dialysis === | ||
Revision as of 13:10, 26 June 2020
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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
Medical Therapy
HAART
With the advent of HAART therapy the renal survival time in patients with HIV-associated nephropathy has greatly slowed the progression to end-stage renal disease. In a case-control study, the use of antiretroviral therapy for a span of 56 days, has been shown to have a protective effect on the renal. In a another retrospective cohort trial, the use of antiretroviral therapy has showed a survival rate of 18.4 months.[1]
Renin–angiotensin–aldosterone system (RAAS) blockade
- In a study, renal survival was increased in patients treated with captopril compared to controls.
- In another study, longer renal survival was reported in patients treated with fosinopril compared to untreated patients.
- Treatment with ACE inhibitor/ARBs in HIV-positive patients is recommended when there is:
- Confirmed or suspected HIV associated nephropathy (HIVAN)
- Significant albuminuria (>30 mg/day in diabetic patients and >300 mg/ day in non-diabetic patients)
- ACE inhibitors/ARBs have protective effects in patients with chronic renal disease (CKD) by:
- Decreasing intraglomerular pressure
- Decreasing inflammatory mediators
- Reducting proteinuria
Corticosteroids
- On renal biopsy of patients with HIVAN there is significant tubulointerstitial inflammation, which has been shown to decrease after steroid treatment.[2]
- In a retrospective cohort study, an association was reported between treatment with corticosteroids and the preservation of renal function in HIVAN patients.[3]
- Another retrospective study, reported that corticosteroids delay the progression of HIVAN to renal insufficiency.[4]
Renal replacement with dialysis
- All patients with HIVAN that have progressed to end stage renal disease (ESRD) should go through renal replacement with dialysis.[5]
- The rates of HIVAN progressing to ESRD increased between 1989 to 2006, but has declined since then to 2011.[6]
- There is no need to isolate HIV positive patients in the dialysis center unlike in infection with hepatitis B.[5]
- Predictors of poor survival for patients with HIVAN and on dialysis are:[7]
References
- ↑ Atta MG, Gallant JE, Rahman MH, Nagajothi N, Racusen LC, Scheel PJ; et al. (2006). "Antiretroviral therapy in the treatment of HIV-associated nephropathy". Nephrol Dial Transplant. 21 (10): 2809–13. doi:10.1093/ndt/gfl337. PMID 16864598.
- ↑ Palau L, Menez S, Rodriguez-Sanchez J, Novick T, Delsante M, McMahon BA; et al. (2018). "HIV-associated nephropathy: links, risks and management". HIV AIDS (Auckl). 10: 73–81. doi:10.2147/HIV.S141978. PMC 5975615. PMID 29872351.
- ↑ Eustace JA, Nuermberger E, Choi M, Scheel PJ, Moore R, Briggs WA (2000). "Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids". Kidney Int. 58 (3): 1253–60. doi:10.1046/j.1523-1755.2000.00280.x. PMID 10972688.
- ↑ Laradi A, Mallet A, Beaufils H, Allouache M, Martinez F (1998). "HIV-associated nephropathy: outcome and prognosis factors. Groupe d' Etudes Néphrologiques d'Ile de France". J Am Soc Nephrol. 9 (12): 2327–35. PMID 9848787.
- ↑ 5.0 5.1 Menez S, Hanouneh M, McMahon BA, Fine DM, Atta MG (2018). "Pharmacotherapy and treatment options for HIV-associated nephropathy". Expert Opin Pharmacother. 19 (1): 39–48. doi:10.1080/14656566.2017.1416099. PMC 6381591. PMID 29224373.
- ↑ Razzak Chaudhary S, Workeneh BT, Montez-Rath ME, Zolopa AR, Klotman PE, Winkelmayer WC (2015). "Trends in the outcomes of end-stage renal disease secondary to human immunodeficiency virus-associated nephropathy". Nephrol Dial Transplant. 30 (10): 1734–40. doi:10.1093/ndt/gfv207. PMC 4829059. PMID 26175146.
- ↑ Atta MG, Fine DM, Kirk GD, Mehta SH, Moore RD, Lucas GM (2007). "Survival during renal replacement therapy among African Americans infected with HIV type 1 in urban Baltimore, Maryland". Clin Infect Dis. 45 (12): 1625–32. doi:10.1086/523728. PMC 4096866. PMID 18190325.