2020 Dec 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.
The human immunodeficiency virus (HIV) is a rapidly evolving virus that has been associated with renal disease since the early days of the HIV epidemic. Classically associated with collapsing focal segmental glomerulosclerosis, direct HIV related nephropathy can also manifest as HIV-immune-complex kidney disease and thrombotic microangiopathy. In recent years, with the advent of combination antiretroviral therapy and effective diffusion of these medications, patients are living longer lives without classic manifestations of the disease. Currently, disorders associated with nephrotoxicity of certain HIV therapies appear to be more prevalent, as well as a surge in non-infectious comorbidities, such as diabetes or hypertension, as etiologies of nephropathy in people living with HIV (PLWHIV). Renal disease remains one of the major causes of mortality in HIV infected patients, with a six-fold increase in mortality for those suffering from acute kidney injury (AKI) and chronic kidney disease (CKD). Furthermore, since HIV can infect and replicate within renal epithelial cells, a full virologic cure may only be feasible with complete eradication of the viral reservoir in the kidney as this compartment appears to act separately from the blood.