Update on HIV Nephrology

By William A. Briggs, M.D.
The Hopkins HIV Report:
A bimonthly newsletter for healthcare providers
Volume 9, Number 1, January 1997

The annual meeting of The American Society of Nephrology was held in November. Several abstracts reported on experimental models of HIV-associated nephropathy (HIVAN), which should be helpful in understanding the pathogenesis of this troublesome complication. Simon and colleagues reported an increased incidence of non-HIV-related end-stage renal disease among the siblings of patients with HIVAN, supporting the notion that genetic factors contribute to the susceptibility to this disease [JASN 7:1343, 1996]. Dr. Jeffrey Kopp is conducting a study at the NIH looking for genetic markers associated with both HIVAN and idiopathic focal segmental glomerulo-sclerosis. For information contact Dr. Kopp at (301) 594-3403.

Burns and associates reported on short-term efficacy of fosinapril, an ACE inhibitor, for the treatment of patients with non-nephrotic and nephrotic range proteinuria. Compared to untreated controls, treated patients had significantly less progression of both proteinuria and renal insufficiency. Renal histology was not documented, however, and treatment was started early in the course of the disease (mean serum creatinine = 1.3 mg/dl) [JASN 7: 1329, 1996].

A separate study by Bird and coauthors supported the efficacy of ACE inhibition in ameliorating the natural history of renal disease and mortality in a transgenic-HIV strain of mice [JASN 7: 1850, 1996]. Despite the report of favorable responses of HIVAN to prednisone treaatment [Smith et al. Amer J Med 101:41,1996], there were no other reports on steroid therapy at the meeting (see Hopkins HIV Report, Vol. 8, No.3, Snapshots). Most nephrologists appear to have reservations regarding this intervention. Dr. Paul Kimmel at the George Washing-ton University Medical Center is currently recruiting patients with HIVAN for a study in which patients will be randomized to prednisone vs. ACE inhibitor vs. placebo. For more in-formation regarding this important study, contact Dr. Kimmel at (202) 994-4244.

This article is from The Johns Hopkins University AIDS Service,
The Hopkins HIV Report: A bimonthly newsletter for healthcare providers.