Human Immunodeficiency Virus (HIV) is a complex condition that can affect various body systems. While treatment advancements have significantly improved the lives of people with HIV, understanding its broader systemic effects, including on kidney health, is important. The kidneys, responsible for filtering waste and excess fluids from the blood, can be vulnerable to complications from HIV infection, its treatments, and associated health conditions.
Direct Impact of HIV on Kidneys
HIV can directly cause HIV-Associated Nephropathy (HIVAN). This condition arises when the HIV virus infects kidney cells, particularly those in the glomeruli and tubules. Glomeruli are tiny filtering units, and tubules reabsorb necessary substances and remove waste. Viral replication within these cells contributes to their damage.
HIV can lead to severe kidney damage, characterized by collapsing focal segmental glomerulosclerosis, which involves scarring in the glomeruli. This direct viral activity and resulting cellular changes can impair the kidneys’ filtering ability. Before widespread antiretroviral therapy (ART), HIVAN was a significant, rapidly progressing complication often leading to end-stage renal disease. While ART has reduced classic HIVAN incidence, the virus’s direct effects on kidney cells remain a concern, especially in advanced HIV disease.
Other Kidney Conditions in People with HIV
Beyond the virus’s direct effects, individuals with HIV can experience kidney problems due to several other factors. Antiretroviral therapy (ART), while essential for managing HIV, can have side effects affecting kidney function. Certain ART medications are nephrotoxic, meaning they can damage the kidneys. This damage may manifest as tubular dysfunction, where kidney tubules do not function properly, or acute kidney injury, a sudden decline in kidney function.
Co-infections also impact kidney health. Hepatitis B and C are common in this population and can independently contribute to kidney damage. Cytomegalovirus (CMV), another common co-infection, has been linked to kidney issues, especially in immunocompromised individuals. These co-infections can lead to immune complex deposition in the kidneys, where antibodies and viral particles form complexes that get trapped and cause inflammation.
Common health conditions, or comorbidities, in people with HIV can also contribute to kidney disease. As people with HIV live longer due to effective ART, conditions like hypertension (high blood pressure) and diabetes are becoming more prevalent. Both are known causes of kidney damage in the general population, and their presence in individuals with HIV can accelerate kidney disease progression. The combination of HIV and these comorbidities can have an additive effect on kidney damage, making regular monitoring important.
Monitoring Kidney Health
Regular monitoring of kidney health is important for individuals with HIV to ensure early detection and management. Kidney problems often lack noticeable symptoms until damage is significant, emphasizing the value of routine screening. Healthcare providers use several diagnostic tests to assess kidney function.
Blood tests commonly measure creatinine levels and estimate the glomerular filtration rate (eGFR). Creatinine is a waste product healthy kidneys filter from the blood; elevated levels indicate ineffective filtering. The eGFR estimates how much blood glomeruli filter per minute, offering a comprehensive view of kidney function.
Urine tests detect proteinuria, excessive protein in the urine. Normally, kidneys retain protein, so its presence in urine signals damage. Regular screening, typically every 3-6 months, allows for timely intervention, which can help slow disease progression and improve long-term outcomes.