HIV associated nephropathy medical therapy: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
=== | |||
=== Combined Antiretroviral Therapy (cART) === | |||
* Treatment with ART is recommended in all HIV-positive patients regardless of their CD4 count.<ref name="pmid29872351" /> | |||
* In a retrospective cohort study, patients with [[Human Immunodeficiency Virus (HIV)|HIV]] associated nephropathy (HIVAN) with cART had a better renal survival compared to patients with no treatment.<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> | |||
* In a cohort study, treatment with cART was associated with reduction in the incidence of HIVAN. | |||
=== Renin–angiotensin–aldosterone system (RAAS) blockade === | === Renin–angiotensin–aldosterone system (RAAS) blockade === | ||
* In a study, renal survival was increased in patients treated with captopril compared to non treated controls.<ref name="pmid8768914">{{cite journal| author=Kimmel PL, Mishkin GJ, Umana WO| title=Captopril and renal survival in patients with human immunodeficiency virus nephropathy. | journal=Am J Kidney Dis | year= 1996 | volume= 28 | issue= 2 | pages= 202-8 | pmid=8768914 | doi=10.1016/s0272-6386(96)90302-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8768914 }} </ref> | * In a study, renal survival was increased in patients treated with [[captopril]] compared to non treated controls.<ref name="pmid8768914">{{cite journal| author=Kimmel PL, Mishkin GJ, Umana WO| title=Captopril and renal survival in patients with human immunodeficiency virus nephropathy. | journal=Am J Kidney Dis | year= 1996 | volume= 28 | issue= 2 | pages= 202-8 | pmid=8768914 | doi=10.1016/s0272-6386(96)90302-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8768914 }} </ref> | ||
* In another study, longer renal survival was reported in patients treated with fosinopril compared to untreated patients.<ref name="pmid12969167">{{cite journal| author=Wei A, Burns GC, Williams BA, Mohammed NB, Visintainer P, Sivak SL| title=Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition. | journal=Kidney Int | year= 2003 | volume= 64 | issue= 4 | pages= 1462-71 | pmid=12969167 | doi=10.1046/j.1523-1755.2003.00230.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12969167 }} </ref> | * In another study, longer renal survival was reported in patients treated with [[fosinopril]] compared to untreated patients.<ref name="pmid12969167">{{cite journal| author=Wei A, Burns GC, Williams BA, Mohammed NB, Visintainer P, Sivak SL| title=Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition. | journal=Kidney Int | year= 2003 | volume= 64 | issue= 4 | pages= 1462-71 | pmid=12969167 | doi=10.1046/j.1523-1755.2003.00230.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12969167 }} </ref> | ||
* Treatment with [[ACE inhibitor]]/[[Angiotensin II receptor antagonist|ARBs]] in HIV-positive patients is recommended when there is:<ref name="pmid25234519">{{cite journal| author=Lucas GM, Ross MJ, Stock PG, Shlipak MG, Wyatt CM, Gupta SK | display-authors=etal| title=Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 9 | pages= e96-138 | pmid=25234519 | doi=10.1093/cid/ciu617 | pmc=4271038 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25234519 }} </ref> | * Treatment with [[ACE inhibitor]]/[[Angiotensin II receptor antagonist|ARBs]] in HIV-positive patients is recommended when there is:<ref name="pmid25234519">{{cite journal| author=Lucas GM, Ross MJ, Stock PG, Shlipak MG, Wyatt CM, Gupta SK | display-authors=etal| title=Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 9 | pages= e96-138 | pmid=25234519 | doi=10.1093/cid/ciu617 | pmc=4271038 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25234519 }} </ref> | ||
** Confirmed or suspected | ** Confirmed or suspected HIVAN | ||
** Significant [[albuminuria]] (>30 mg/day in [[Diabetes mellitus|diabetic]] patients and >300 mg/ day in non-diabetic patients) | ** Significant [[albuminuria]] (>30 mg/day in [[Diabetes mellitus|diabetic]] patients and >300 mg/ day in non-diabetic patients) | ||
Revision as of 13:43, 26 June 2020
|
HIV associated nephropathy Microchapters |
|
Differentiating HIV associated nephropathy from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
HIV associated nephropathy medical therapy On the Web |
|
American Roentgen Ray Society Images of HIV associated nephropathy medical therapy |
|
Risk calculators and risk factors for HIV associated nephropathy medical therapy |
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
Combined Antiretroviral Therapy (cART)
- Treatment with ART is recommended in all HIV-positive patients regardless of their CD4 count.[1]
- In a retrospective cohort study, patients with HIV associated nephropathy (HIVAN) with cART had a better renal survival compared to patients with no treatment.[2]
- In a cohort study, treatment with cART was associated with reduction in the incidence of HIVAN.
Renin–angiotensin–aldosterone system (RAAS) blockade
- In a study, renal survival was increased in patients treated with captopril compared to non treated controls.[3]
- In another study, longer renal survival was reported in patients treated with fosinopril compared to untreated patients.[4]
- Treatment with ACE inhibitor/ARBs in HIV-positive patients is recommended when there is:[5]
- Confirmed or suspected 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 proteinuria and the deterioration rate of renal function.[6]
Corticosteroids
- On renal biopsy of patients with HIVAN there is significant tubulointerstitial inflammation, which has been shown to decrease after steroid treatment.[1]
- In a retrospective cohort study, an association was reported between treatment with corticosteroids and the preservation of renal function in HIVAN patients.[7]
- Another retrospective study, reported that corticosteroids delay the progression of HIVAN to renal insufficiency.[8]
Renal replacement with dialysis
- All patients with HIVAN that have progressed to end stage renal disease (ESRD) should go through renal replacement with dialysis.[9]
- The rates of HIVAN progressing to ESRD increased between 1989 to 2006, but has declined since then to 2011.[10]
- There is no need to isolate HIV positive patients in the dialysis center unlike in infection with hepatitis B.[9]
- Predictors of poor survival for patients with HIVAN and on dialysis are:[11]
References
- ↑ 1.0 1.1 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.
- ↑ 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.
- ↑ Kimmel PL, Mishkin GJ, Umana WO (1996). "Captopril and renal survival in patients with human immunodeficiency virus nephropathy". Am J Kidney Dis. 28 (2): 202–8. doi:10.1016/s0272-6386(96)90302-9. PMID 8768914.
- ↑ Wei A, Burns GC, Williams BA, Mohammed NB, Visintainer P, Sivak SL (2003). "Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition". Kidney Int. 64 (4): 1462–71. doi:10.1046/j.1523-1755.2003.00230.x. PMID 12969167.
- ↑ Lucas GM, Ross MJ, Stock PG, Shlipak MG, Wyatt CM, Gupta SK; et al. (2014). "Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America". Clin Infect Dis. 59 (9): e96–138. doi:10.1093/cid/ciu617. PMC 4271038. PMID 25234519.
- ↑ Sarafidis PA, Khosla N, Bakris GL (2007). "Antihypertensive therapy in the presence of proteinuria". Am J Kidney Dis. 49 (1): 12–26. doi:10.1053/j.ajkd.2006.10.014. PMID 17185142.
- ↑ 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.
- ↑ 9.0 9.1 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.