ESRD From HIV-Associated Nephropathy: Important Condition, Interesting Trend

Before the development of highly active antiretroviral therapy (HAART), HIV-associated nephropathy was an important cause of progressive kidney disease in patients infected with the virus and particularly among African Americans. As life span for HIV-infected patients has dramatically improved, however, it is not clear whether end-stage renal disease (ESRD) from HIV-associated nephropathy has followed a similar pattern.

A recent study published in the Journal of the American Medical Association¹ examined the trends and incidence ratios of ESRD from HIV-associated nephropathy in the United States between 2001 and 2010. The study examined the United States Renal Data System standard analysis files to study US patients who initiated maintenance renal replacement therapy (RRT) in that decade. US Census data were used to identify patients’ demographic characteristics.

The authors found that at the beginning of the study period (2001 to 2002), the number of cases of ESRD related to HIV-associated nephropathy requiring RRT, was 2.9 cases per million per year. Standardized incidence ratios declined for the overall population over time. Interestingly, however, they identified an increase in the standardized incidence ratio for patients aged 65 years and older and for non-Hispanic whites.  

Like much progress in the treatment of epidemic disease, good news often comes with a caveat. In this case, with illumination of the strides made in slowing the incidence of HIV-associated ESRD, comes the fact that not all populations are being affected equally.

Primary care physicians caring for persons infected with HIV should be aware of the importance of HIV-associated nephropathy and of its disproportionate increase in patients older than 65 years and non-Hispanic whites.  

References:

Sexton DJ, Reule S, Solid C, Collins AJ, Foley RN. End-stage renal disease from human immunodeficiency virus-associated nephropathy in the United States, 2001 through 2010. JAMA Intern Med. March 3, 2014. doi:10.1001/jamainternmed.2014.29. [Epub ahead of print.]