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HIV, Medication, and Kidney Disease

Introduction

Antiretroviral therapy, or ART, is helping people with HIV live longer and better than ever before. However, if you have HIV, you’re still at a higher risk of other medical problems, including kidney disease. Kidney disease can be a result of HIV infection or the drugs used to treat it. It’s treatable in many cases.

Here are a few things you should know about your risks and what you can do to lower them.

What your kidneys do

Causes

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 your urine. Each of your kidneys has more than a million tiny filters ready to cleanse your blood of waste products.

Like other parts of your body, your kidneys can be injured. Injuries can happen from illness, trauma (like an accident), or from taking certain medications. When your kidneys are injured, they can’t perform their job as they should. Poor function can lead to a buildup of waste products and fluids in your body. Kidney disease can cause fatigue, swelling in your legs, muscle cramps, mental confusion, and even death.

How HIV can damage your kidneys

Complications

People who have HIV infection plus elevated viral loads or low CD4 cell (T-cell) counts are more likely to have chronic kidney disease. The HIV virus can attack the filters in the kidneys and stop them from working their best. This effect is called HIV-associated nephropathy, or HIVAN.

Additionally, your risk of kidney disease may be increased if you:

  • have diabetes, high blood pressure, or hepatitis C
  • are older than 65 years
  • have a family member with kidney disease
  • are African American, Asian, American Indian, Hispanic American, or Pacific Islander
  • have used medications that damage your kidneys for several years

In some cases, these additional risks can be minimized. For instance, if you can manage your high blood pressure, diabetes, or hepatitis C, you can decrease the risk from these conditions. Also, HIVAN isn’t common in people with a low viral load who have T-cell counts within a normal range. So, take your medication exactly as prescribed to keep these numbers where they should be. This can also help you avoid kidney damage.

You may not have any of these risk factors for direct HIV-induced kidney damage. However, you may still be at increased risk of kidney damage from the medications you take to manage your HIV infection.

ART and kidney disease

Pills

ART can be very effective at lowering your viral load, boosting your T-cell numbers, and stopping HIV from attacking your body. However, some of these powerful drugs can cause kidney problems in some people.

Medications such as adefovir (Hepsera) and tenofovir (the drug in Viread and one of the combination of drugs in Truvada and Atripla) can affect your kidneys’ filtration system. In some people, indinavir (Crixivan), atazanavir (Reyataz), and drugs called HIV protease inhibitors can crystalize inside the drainage system in the kidneys. This leads to the development of kidney stones.

Getting tested for kidney disease

when to see a doctor

Experts recommend that everyone who has tested positive for HIV also get tested for kidney disease. Your doctor will most likely do blood and urine tests. These tests measure the level of protein in your urine and the level of the waste product creatinine in your blood. The results help your doctor determine how well your kidneys are working.

Managing HIV and kidney disease

Symptoms

Kidney disease is a complication of HIV that is usually manageable. Make sure to schedule and keep your appointments for follow-up care with your doctor. Then, work with your doctor to manage all of your health conditions to reduce your risk of more problems.

You asked, we answered

  • Are there treatments if I do develop kidney disease?
  • There are many options that your doctor can explore with you. They may adjust your dosage of ART or give you blood pressure medication or diuretics (water pills) or both. Your doctor may also consider dialysis to clean your blood. Kidney transplant may also be an option. Your treatment will depend on when your kidney disease was discovered and how severe it is. Other health conditions you have will also factor in.

    - Healthline Medical Team

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