HIVAN, pediatric

Abstract

HIV-associated nephropathy (HIVAN) is a renal disease that affects HIV+ people of African ancestry with a high viral load and a genetic predisposition to develop this disease. From the clinical point of view, HIVAN is characterized by heavy proteinuria, nephrotic syndrome, and rapid progression to end-stage kidney disease (ESKD). Renal histological studies show focal segmental glomerulosclerosis (FSGS), collapsing glomerulopathy, which is less common in children, and microcystic tubular dilatation. HIVAN has a significant clinical impact in the quality of life and survival of HIV+ children. This chapter will discuss relevant issues related to the diagnosis, pathogenesis, clinical outcome, and treatment of children with HIVAN, focusing on the most relevant renal pathological, genetic, and virological factors that precipitate this renal disease. HIV-1 infection of renal epithelial cells appears to play a key role in this process, at least partially by inducing chronic renal epithelial injury, and triggering a persistent renal inflammatory and regenerative response that leads to renal enlargement and rapid progression of the renal disease. New antiretroviral therapies (ART) have been efficient in preventing and improving the outcome of children with HIVAN, and significant progress has been made in the field of renal transplantation in HIV+ people. However, physicians have had less success providing chronic ART to HIV+ children and adolescents, and HIVAN remains a problem in children of African ancestry all over the world. In addition, some antiretroviral drugs can induce renal injury per se. Overall, better prevention and treatment programs are needed to eradicate this renal disease in children.