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Kidney disease from HIV and its medications

For many people, a diagnosis of HIV infection is not the seeming death sentence it was in the 1980s. People who are HIV-positive are living longer and better than ever before thanks to antiretroviral therapy (ART). The infection still presents difficulties, however. HIV medications are mostly effective and the disease is relatively manageable. However, people with HIV have a higher risk of developing kidney disease, whether as a result of the infection itself or as a side effectfrom their cocktail of HIV medications.

Kidney disease is treatable in many cases. However, it can be more challenging to manage in someone who already has HIV.

A brief kidney primer

Your kidneys are your body’s filtering system.

This pair of organs removes toxins and excess fluid from your body. The fluid eventually leaves your body through urination. Each of your kidneys has more than a million tiny filters ready to cleanse your blood of waste products.

If one or both of your kidneys are injured or diseased in some way — through illness, trauma (like an accident), or from taking certain medications — they can’t perform their job the way they should. This can lead to a build up of waste products and fluids in your body. Kidney disease can cause fatigue, swelling in your legs, muscle cramps, mental confusion, more severe symptoms, and even death.

Who gets kidney disease?

HIV raises your risk for having kidney disease, but people who aren’t HIV-positive can develop kidney disease too.

Your risk for kidney injuries and disease may increase if you:

Have diabetes, high blood pressure, or hepatitis C

Are older than 65 years

Have a family member with kidney disease

Are Negro, Asian, American Indian, or Hispanic

Use medications that damage the kidneys

If you fall into any of these categories and have HIV, your risk is even higher. AIDS. government estimates that up to 30 percent of people who have HIV or AIDS also has some form of kidney disease.

How does HIV damage the kidneys?

The big question is: how does HIV lead to kidney damage? The answers, unfortunately, aren’t always straightforward. People who are HIV-positive and have elevated viral loads (high amounts of HIV in the blood) or low CD4 cell counts (the blood cells that are targeted by the infection) are more likely to have chronic kidney disease.

Happily, there has been research over the last several years indicating that effective control of HIV replication and coincident improvement in CD4 counts can improve or at least slow down this kidney damage.

The HIV virus can also attack the filters in the kidneys, making them unable to perform their job at top capacity. This is called HIV-associated nephropathy, or HIVAN.

Some people who have HIV also have another chronic disease, such as diabetes. A possible result of taking HIV medication, diabetes damages kidneys and can lead to serious problems. A person with HIV may also have hepatitis C virus (HCV). HCV damages the liver, but it can also cause kidney disease.

Both hepatitis C and HIV can be spread through intravenous drug use when using contaminated paraphernalia, so the conditions share some risks as well.

Some patients with HIV may be not have direct HIV-induced kidney damage, but they may develop kidney injuries due to the medications they take to fight HIV.

ART and Kidney disease

Antiretroviral therapy (ART) medications can be a bright spot in the life of someone with HIV. The medications help stop the virus from attacking the body, boost fighter cell numbers, and clearly prolong the lives of HIV-infected persons.

However, some of these powerful drugs can cause kidney problems in some people.

Medications such as adefovir (Hepsera) and tenofovir (an ART medication that can be prescribed alone (Viread) and is also a component found in various combination products like Truvada and Atripla) can affect the kidneys’ filtration system.

Indinavir (Crixivan) and atazanavir (Reyataz), as well as other so-called HIV protease inhibitors, may actually crystalise inside the kidneys’ drainage system in some patients.

This leads to the development of kidney stones and the problems associated with those.

Should you get tested for kidney disease?

Experts recommend that everyone who has tested positive for HIV also get tested for kidney disease.

Blood and urine tests can measure the level of protein in your urine and waste product (called creatinine) in your blood. These tests help determine how well your kidneys are working.

Managing HIV and

Kidney disease

Although kidney disease is a complication of HIV you may not have expected, it’s manageable.

There are many treatment options to explore, including:

Adjusting the dosage of ART

Medication

Taking blood pressure medication

Having dialysis to clean the blood

Kidney transplant

The important part is getting tested so you know what you’re up against. Then, work with your doctor to manage all of your health conditions to reduce your risk of more problems. — healthline.com