HIV and end-stage renal disease: Practical issues in management
According to UNAIDS data there are 40 million HIV-infected people around the globe. An uncommon complication of HIV is HIV-associated nephropathy (HIVAN), and this condition is expected to be one of the leading causes of end-stage kidney disease (EKD) in black men in the new millennium. Patients present with an immune complex glomerulopathy and focal segmental glomerulosclerosis together with proteinuria and haematuria and occasionally severe hypertension. Peripheral oedema is unusual. In the era before antiretroviral therapy (ART) the median survival in the HIV-infected population on dialysis was 10 months. However, since the introduction of highly active antiretroviral therapy (HAART) and optimal prevention of opportunistic infections, a life expectancy of 10 - 20 years can be expected. Unfortunately patients infected with HIV are often excluded from renal replacement therapy (RRT) programmes despite such encouraging outcomes and despite the fact that the outcome of renal transplantation in HIV patients is comparable to that in HIV-negative recipients at 1-year follow-up in experienced centres. In the South African context HIV/AIDS has an alarming prevalence, although dialysis and transplantation are offered only to very few and often only in the acute state. In the light of the new data, HIV seropositivity (especially when the patient is receiving HAART) needs to be reconsidered as an absolute contraindication to renal replacement.
Southern African Journal of HIV Medicine Vol. 7 (1) 2006: pp. 39-43
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