HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention.

Autor:	Husain NE; Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan., Ahmed MH; Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK., Almobarak AO; Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan., Noor SK; Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan., Elmadhoun WM; Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan., Awadalla H; Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan., Woodward CL; Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK., Mital D; Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK.
Jazyk:	angličtina
Zdroj:	Journal of clinical medicine research [J Clin Med Res] 2018 Jan; Vol. 10 (1), pp. 1-8. Date of Electronic Publication: 2017 Dec 01.
DOI:	10.14740/jocmr3235w
Abstrakt:	The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "HIVAN" and "pathology and clinical presentation", in addition to "prevalence and risk factors for HIVAN", with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/µL. Other clinical presentations in African populations include acute kidney injury (AKI), nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN. Competing Interests: The authors declare that they have no competing interests.
Databáze:	MEDLINE
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