Antiretroviral therapy is helping people with HIV live longer and better than ever before. However, people with HIV still have a higher risk of other medical problems, including kidney disease. Kidney disease can be a result of an HIV infection or the drugs used to treat it. Fortunately, in many cases, kidney disease is treatable.
Here are a few things to know about the risks of kidney disease in people with HIV.
The kidneys are the body’s filtering system. This pair of organs removes toxins and excess fluid from the body. The fluid eventually leaves the body through urine. Each of the kidneys has more than a million tiny filters ready to cleanse the blood of waste products.
Like other body parts, the kidneys can be injured. Injuries can be caused by illness, trauma, or certain medications. When the kidneys are injured, they can’t perform their job properly. Poor kidney function can lead to a buildup of waste products and fluids in the body. Kidney disease can cause fatigue, swelling in the legs, muscle cramps, and mental confusion. In severe cases, it can cause death.
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, the risk of kidney disease may be higher in people who:
- have diabetes, high blood pressure, or hepatitis C
- are older than 65 years
- have a family member with kidney disease
- are African American, Native American, Hispanic American, Asian, or Pacific Islander
- have used medications that damage the kidneys for several years
In some cases, these additional risks can be reduced. For instance, proper management of high blood pressure, diabetes, or hepatitis C can decrease the risk of developing kidney disease from these conditions. Also, HIVAN isn’t common in people with a low viral load who have T cell counts within a normal range. Taking their medication exactly as prescribed can help people with HIV keep their viral load and T cell counts where they should be. Doing this can also help prevent kidney damage.
Some people with HIV may not have any of these risk factors for direct HIV-induced kidney damage. However, the medications that manage HIV infection may still cause an increased risk of kidney damage.
Antiretroviral therapy can be very effective at lowering viral load, boosting T cell numbers, and stopping HIV from attacking the body. However, certain antiretroviral drugs can cause kidney problems in some people.
Medications that can affect the kidney’s filtration system include:
- tenofovir, the drug in Viread and one of the drugs in the combination medications Truvada, Atripla, Stribild, and Complera
- indinavir (Crixivan), atazanavir (Reyataz), and other HIV protease inhibitors, which can crystalize inside the drainage system of the kidneys, causing kidney stones
Experts recommend that people who have tested positive for HIV also get tested for kidney disease. To do this, a healthcare provider will most likely order blood and urine tests.
These tests measure the level of protein in the urine and the level of the waste product creatinine in the blood. The results help the provider determine how well the kidneys are working.
Kidney disease is a complication of HIV that is usually manageable. It’s important for people with HIV to schedule and keep appointments for follow-up care with their healthcare provider. During these appointments, the provider can discuss how best to manage health conditions to reduce the risk of further problems.
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 TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.