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World AIDS day:
World AIDS Day, designated on 1 December every year since 1988, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection, and mourning those who have died of the disease.

World AIDS Day is one of the eight official global public health campaigns marked by the World Health Organization (WHO).

As of 2013, AIDS has killed more than 36 million people worldwide (1981-2012), and an estimated 35.3 million people are living with HIV, making it one of the most important global public health issues in recorded history. Despite recent improved access to antiretroviral treatment in many regions of the world, the AIDS epidemic claims an estimated 2 million lives each year, of which about 270,000 are children.

What is HIV/AIDS?
Human immunodeficiency virus (HIV) is a replicating virus or retrovirus that can lead to acquired immunodeficiency syndrome (AIDS). AIDS is a health condition that causes the immune system to fail, which leads to a number of life-threatening infections and complications. HIV is transmitted when infected body fluid such as blood, semen, vaginal fluid and breast milk come into contact with a mucous membrane or the bloodstream of another person. Although HIV and AIDS medicines help slow the progression of the virus, there is no cure for HIV or AIDS.

Kidney disease is common in people living with HIV/AIDS—up to 30% have abnormal kidney function. HIV can affect your kidneys in many different ways, but the most common are HIV-associated nephropathy and nephrotoxicity.

HIV ASSOCIATED NEPHROPATHY (HIVAN)
HIVAN is damage to your kidneys caused by the Human Immunodeficiency Virus (HIV) itself. African American men with HIV/AIDS seem to be most at risk for developing HIVAN. It is most common in patients with CD4 counts less than 200 cells/mm3, but it can occur at any CD4 count.
HIVAN is extremely uncommon in individuals with HIV who have a suppressed viral load (a low amount of HIV in their blood). Therefore, if you have HIVAN, it is very important to be started on antiretroviral therapy (ART) at the earliest sign of kidney problems—and to stay on it—no matter what your CD4 count is. Research shows that people who have HIVAN can stay healthy and live longer by staying on ART.

NEPHROTOXICITY
“Nephrotoxicity” is a term that means “toxicity or injury to the kidneys.” For people living with HIV/AIDS, nephrotoxicity can be an adverse side effect of certain HIV medications, including protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTIs—commonly called “nukes”).
Your kidneys clear many medications from your body, so if your kidneys aren’t working properly, your healthcare provider may need to adjust the HIV meds that you are taking. Sometimes that means changing which HIV meds you take; other times it means changing your dosage. Work with your healthcare provider to find a treatment regimen that works for you.

How does HIV/AIDS affect the kidneys?
HIV-related kidney problems are commonly known as HIV-associated nephropathy (HIVAN). Up to 30 percent of people with HIV or AIDS have protein in their urine, a sign of abnormal kidney function, and about 10 percent of people with HIV develop kidney disease. This means HIV patients make up 1 to 2 percent of the end stage renal disease (ESRD) population.
Renal problems related to HIV can be caused directly by the HIV virus when it enters the kidneys and multiplies or by the medicines patients must take to manage HIV. Highly active antiretroviral therapy (HAART) and other HIV treatments have side effects that can sometimes be toxic to the kidneys, including:

  • lactic acidosis — a buildup of lactic acid in the body
  • crystal-induced obstruction — a buildup of crystals in the kidneys
  • interstitial nephritis — a disorder in which tissues surrounding the kidneys become inflamed
  • electrolyte abnormalities — abnormalities in the body’s levels of sodium, potassium or calcium

Treatment for CKD
HIV-positive patients who have or are at risk for CKD should have their treatment tailored to their needs and circumstances. Some treatments for CKD include managing phosphorus levels, reducing blood pressure, managing fluid balance and/or antiretroviral therapy.
The six classes of antiretroviral medications approved by the Food and Drug Administration are: Nucleoside reverse transcriptase inhibitors (NRTIs), Non-nucleoside reverse transcriptase inhibitors (NNRTIs), Protease inhibitors (PIs), Entry inhibitors, Fusion inhibitors and Integrase inhibitors.

  • Nucleoside reverse transcriptase inhibitors (NRTIs) bind to and disable reverse transcriptase, a protein that HIV needs to make more copies of itself.
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) create faulty versions of building blocks that HIV needs to make more copies of itself. When HIV uses one of these faulty building blocks instead of a normal building block, reproduction of the virus is stalled.
  • Protease inhibitors (PIs) disable protease, a protein that HIV needs to make more copies of itself.
  • Entry inhibitors work by blocking HIV entry into cells.
  • usion inhibitors work by blocking HIV entry into cells.
  • Integrase inhibitors disable one of the proteins that HIV uses to insert its viral genetic material into the genetic material of an infected cell.

HIV-positive people with ESRD who are on dialysis may want to consider a kidney transplant. Doctors can help HIV-positive patients with CKD and end stage renal disease determine a treatment regimen that manages both HIV and kidney disease.

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