How is HIV associated with end-stage renal disease (ESRD)?

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Cutaneous disease occurs in 60-100% of patients infected with human immunodeficiency virus (HIV). Seborrheic dermatitis, the most common cutaneous condition seen in individuals infected with HIV, usually develops early and increases in severity as the CD4 count falls. Other cutaneous disorders are relatively unique to patients with acquired immunodeficiency syndrome (AIDS) and appear only when the CD4 count is critically low, usually less than 200 cells per µL. Included in these disorders are eosinophilic folliculitis, oral hairy leukoplakia, bacillary angiomatosis, and Kaposi sarcoma. [17]

HIV-associated nephropathy (HIVAN) is a syndrome of massive proteinuria, hematuria, and azotemia, most commonly in a normotensive, young black male. [18] The renal histology is that of focal segmental glomerulosclerosis. Data now suggest a direct role for HIV infection and viral replication within renal cells in the pathogenesis of HIVAN. Additional information suggests that early initiation of highly active antiretroviral therapy (HAART) [19, 20, 21, 22] and/or an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) [23, 24] may stabilize, or perhaps even restore, renal function in those with HIVAN.

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