Acute Kidney Injury in Hospitalized HIV-Infected Patients in the HAART Era: An Epidemiological View

Abstract

Actually, more than 30 million people are affected with human immunodeficiency virus (HIV) infection worldwide [1]. Since the introduction of the highly active antiretroviral therapy (HAART) at the end of 1995, overall mortality of patients with HIV infection decreased dramatically as well as mortality caused by HIV infection or by an Acquired Immunodeficiency Syndrome (AIDS)-defining disease. Conversely, mortality due to kidney disease, liver disease, heart disease, and non-AIDS-defining cancers has proportionally increased [2,3,4]. Renal disorders in HIV-infected patients can present as an acute or chronic condition and they are associated with increased morbidity and mortality in this population [5,6,7,8,9]. Acute kidney injury is a common complication in ambulatory HIV-infected patients treated with HAART and has been associated with prior renal impairment, lower CD4 levels, AIDS, hepatitis C virus (HCV) co-infection, and liver disease [10,11]. HIV-infected patients are also at increased risk for AKI development within hospitalization, related to volume depletion, sepsis, and the acute administration of nephrotoxic medications or radiocontrast. Before the advent of HAART, studies addressing AKI on HIV-infected patients typically included only severe cases of AKI which were identified through hospital records or biopsy databases [12,13,14]. The epidemiology of AKI in hospitalized HIV-infected patients in the HAART era has also not been extensively analyzed. In fact, few studies have focused on the clinical characteristics of AKI in hospitalized HIVinfected patients in the HAART era [15,16,17,18]. In this chapter, we provide a critical and contemporary review of AKI in hospitalized HIV-infected patients in the HAART era, focusing on the incidence, risk factors, and outcome.