HIV-associated kidney disease: the changing spectrum and treatment priorities.

IF 2.2 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Current Opinion in Nephrology and Hypertension Pub Date : 2024-11-01 Epub Date: 2024-08-19 DOI:10.1097/MNH.0000000000001018

Nicola Wearne, Bianca Davidson

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Abstract

Purpose of review: This review examines the impact of HIV on kidney disease, which remains significant despite advances in antiretroviral therapy (ART). The review is timely due to the shifting epidemiology of kidney disease in people with HIV (PWH), driven by increased ART access, noncommunicable diseases, and region-specific opportunistic infections like tuberculosis.

Recent findings: The literature highlights a decline in HIV-associated nephropathy (HIVAN) and a rise in tubulointerstitial diseases and noncommunicable diseases among PWH. Studies from the United States and South Africa report decreased HIVAN prevalence and increased rates of tubulointerstitial diseases linked to tenofovir disoproxil fumarate (TDF) toxicity and tuberculosis (TB). Immune complex glomerulonephritis (ICGN) and diabetic kidney disease (DKD) are also prevalent.

Summary: The findings underscore the need for improved diagnostic tools for opportunistic infections, management of ART-related complications, and strategies to address noncommunicable diseases in PWH. There is a need to centralize care to address all health needs simultaneously. Future research should focus on APOL1-targeted therapies and the role of SGLT2 inhibitors in CKD. Enhanced transplantation outcomes and the development of guidelines for managing DKD in PWH are critical for advancing clinical practice and improving patient outcomes.

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艾滋病相关肾病：不断变化的病谱和治疗重点。

综述的目的：本综述探讨了 HIV 对肾脏疾病的影响，尽管抗逆转录病毒疗法（ART）取得了进展，但肾脏疾病仍然十分严重。由于抗逆转录病毒疗法的普及、非传染性疾病以及结核病等地区性机会性感染的增加，艾滋病病毒感染者（PWH）肾脏疾病的流行病学发生了变化，因此本综述非常及时：文献强调了艾滋病病毒相关肾病（HIVAN）的减少以及肾小管间质疾病和非传染性疾病在艾滋病病毒感染者中的增加。美国和南非的研究报告显示，HIVAN 患病率下降，而与替诺福韦二吡呋酯（TDF）毒性和结核病（TB）相关的肾小管间质疾病患病率上升。小结：研究结果表明，有必要改进机会性感染的诊断工具、抗逆转录病毒疗法相关并发症的管理以及应对威利什病患者非传染性疾病的策略。有必要进行集中护理，以同时满足所有健康需求。未来的研究应侧重于 APOL1 靶向疗法和 SGLT2 抑制剂在慢性肾功能衰竭中的作用。提高移植结果和制定管理威利什人慢性肾脏病的指南对于推进临床实践和改善患者预后至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.