HIV-associated nephropathy: A decade of clinical outcomes, global disparities and emerging promise.

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2026-09-29 DOI:10.1111/hiv.70315

Deepak V Pathiyil, Nicola Wearne, Brendon Price, Frank Post, Dami A Collier

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引用次数: 0

Abstract

Objective: To review the pathogenesis, epidemiology, clinical presentation, management and outcomes of HIV-associated nephropathy (HIVAN), with emphasis on global disparities, genetic susceptibility (APOL1) and emerging therapeutic and technological advances.

Design: Narrative literature review synthesizing contemporary evidence from clinical cohorts, translational research and guideline-based practice, with comparative perspectives from high-resource (UK) and low-resource (sub-Saharan Africa) settings.

Methods: Relevant studies were analysed to evaluate mechanisms of disease, epidemiological trends, diagnostic approaches, treatment strategies and long-term outcomes. Particular focus was placed on APOL1-associated risk, antiretroviral therapy (ART) impact and recent developments including artificial intelligence (AI) applications and targeted therapies.

Results: HIVAN arises from direct HIV infection of renal epithelial cells in genetically susceptible individuals, particularly those with APOL1 risk variants. ART has significantly reduced incidence in high-income settings, whereas HIVAN remains prevalent in sub-Saharan Africa due to delayed diagnosis and limited healthcare access. Clinically, HIVAN presents with proteinuria and progressive kidney dysfunction, requiring biopsy for confirmation. Early ART initiation improves renal outcomes, supported by adjunctive therapies such as renin-angiotensin system blockade and SGLT2 inhibitors. Emerging therapies targeting APOL1 and advances in AI-driven risk prediction and diagnostics show promise.

Conclusions: HIVAN reflects an interplay between viral, genetic and socio-economic factors. While ART has transformed outcomes in well-resourced settings, significant global disparities persist. Future progress depends on improving HIV care access, expanding renal services and advancing precision medicine approaches, including APOL1-targeted therapies and AI-enabled risk stratification.

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艾滋病相关肾病：十年临床结果、全球差异和新前景

目的：回顾hiv相关肾病（HIVAN）的发病机制、流行病学、临床表现、管理和结局，重点介绍全球差异、遗传易感性（APOL1）以及新兴的治疗和技术进展。设计：叙述性文献综述，综合来自临床队列、转化研究和基于指南的实践的当代证据，并从资源丰富（英国）和资源匮乏（撒哈拉以南非洲）的环境中进行比较。方法：对相关研究进行分析，评价发病机制、流行趋势、诊断方法、治疗策略和远期疗效。特别侧重于apol1相关风险、抗逆转录病毒治疗（ART）的影响以及包括人工智能（AI）应用和靶向治疗在内的最新发展。结果：在遗传易感的个体中，HIV直接感染肾上皮细胞引起HIV感染，特别是那些有APOL1风险变异的个体。抗逆转录病毒治疗显著降低了高收入环境中的发病率，而艾滋病毒感染在撒哈拉以南非洲仍然普遍存在，原因是诊断延迟和获得医疗服务的机会有限。临床上，hiv表现为蛋白尿和进行性肾功能障碍，需要活检证实。在辅助治疗如肾素-血管紧张素系统阻断和SGLT2抑制剂的支持下，早期开始抗逆转录病毒治疗可改善肾脏预后。针对APOL1的新疗法以及人工智能驱动的风险预测和诊断的进展显示出希望。结论：hiv反映了病毒、遗传和社会经济因素之间的相互作用。虽然抗逆转录病毒治疗在资源充足的环境中改变了结果，但重大的全球差距仍然存在。未来的进展取决于改善艾滋病毒护理的可及性、扩大肾脏服务和推进精准医疗方法，包括apol1靶向治疗和人工智能支持的风险分层。

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

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.