Recent Progress in HIV-Associated Nephropathy

AbstractThe classic kidney disease ofHIV infection,HIV-associated nephropathy(HIVAN), is an aggressive form of collapsing focal segmentalglomerulosclerosis with accompanying tubular and interstitial lesions.HIVAN was first described among African-Americans and Haitian immigrantswith advanced HIV disease, an early suggestion of a stronggenetic association. This genetic susceptibility was recently linked topolymorphisms on chromosome 22 in individuals of African descent.The association with advanced HIV infection and evidence from HIVtransgenicmice suggested the possibility that HIV directly infects thekidney and that specific HIV gene expression induces host cellular pathwaysthat are responsible for HIVAN pathogenesis. Although combinationantiretroviral therapy has substantially reduced the impact ofHIVAN in the United States, continued growth of the HIV epidemicin susceptible African populations may have important public healthimplications. This article reviews recent progress in the pathogenesisand treatment of HIVAN and describes the changing epidemiology ofHIV-related kidney disease.