What is HIV/AIDS?

Human immunodeficiency virus (HIV) is a retrovirus that can lead to acquired immunodeficiency syndrome (AIDS). AIDS is a condition that weakens the immune system, making the body vulnerable to life-threatening infections and complications. HIV is transmitted through infected body fluids like blood, semen, vaginal fluid, and breast milk when they contact another person’s mucous membrane or bloodstream. While medicines can slow HIV and AIDS progression, there is no cure for these conditions.

Impact of HIV/AIDS on the Kidneys

Kidney issues related to HIV are often referred to as HIV-associated nephropathy (HIVAN). Approximately 30% of HIV or AIDS patients exhibit protein in their urine, indicating abnormal kidney function. About 10% of HIV patients develop kidney disease, accounting for 1 to 2% of the end-stage renal disease (ESRD) population.

HIV can directly affect the kidneys as the virus enters and multiplies within them, or it can result from medications used to manage HIV. Highly active antiretroviral therapy (HAART) and other HIV treatments may have side effects that can harm the kidneys, including:

• Lactic acidosis: Buildup of lactic acid in the body
• Crystal-induced obstruction: Accumulation of crystals in the kidneys
• Interstitial nephritis: Inflammation of tissues around the kidneys
• Electrolyte abnormalities: Imbalances in sodium, potassium, or calcium levels in the body

Diagnosing Chronic Kidney Disease (CKD)

CKD symptoms often appear after substantial kidney function loss, including symptoms like swelling in the legs or face, changes in urination, fatigue, and loss of appetite. Due to the similarity of CKD symptoms with other health issues, prompt diagnosis can be challenging.

The primary test to assess kidney function is a urine test using a dipstick to measure protein, sugar, ketones, blood, nitrites, and red and white blood cells. Roughly one-third of HIV patients have elevated protein levels in their urine, indicating potential kidney problems. If protein is detected, further kidney tests such as blood urea nitrogen (BUN) or creatinine clearance tests may be ordered.

A BUN test measures nitrogen levels in the blood, which increase when protein is metabolized. High nitrogen levels suggest kidney function issues since the kidneys usually remove nitrogen from the body.

A creatinine clearance test assesses the kidneys’ waste elimination capability. Low waste levels in the blood and urine may signify impaired kidney function.

Treating Chronic Kidney Disease (CKD)

HIV-positive patients at risk of or diagnosed with CKD require personalized treatment to manage their unique needs. CKD treatment strategies encompass various aspects, including phosphorus level regulation, blood pressure control, fluid balance management, and antiretroviral therapy.

Antiretroviral medications fall into six categories approved by the Food and Drug Administration:

• Nucleoside reverse transcriptase inhibitors (NRTIs): Inhibit HIV’s ability to make copies of itself by disabling reverse transcriptase.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Create defective building blocks that impede HIV replication.
• Protease inhibitors (PIs): Hinder protease, a protein vital for HIV replication.
• Entry inhibitors: Block HIV entry into cells.
• Fusion inhibitors: Prevent HIV from entering cells.
• Integrase inhibitors: Disable a protein HIV uses to insert its genetic material into host cells.

HIV-positive individuals with ESRD who are on dialysis may consider kidney transplantation. Healthcare providers can assist CKD and end-stage renal disease patients with HIV in developing a treatment plan that effectively manages both conditions.