HIV-associated nephropathy

HIVAN is the most common cause of chronic renal failure in HIV-1 seropositive patients and disproportionately affects patients of African descent. Patients with HIVAN are typically diagnosed late in the course of their HIV illness when they present with renal insufficiency and proteinuria. HIV-1 infection of renal epithelial cells has been shown to be crucial in the initiation of HIVAN pathogenesis. Furthermore, the kidney represents a reservoir where HIV-1 infection can persist despite treatment with HAART. Small clinical trials, case reports, and epidemiologic data strongly suggest a benefit of HAART in the treatment of HIVAN. Although not currently the standard, we recommend that the diagnosis of HIVAN be sought aggressively by physicians caring for HIV infected patients. And, when found, we also recommend that patients be started on HAART independent of their CD4 cell count and viral load.