Interventions for HIV‐associated nephropathy
Abstract
Background
Human immunodeficiency virus associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in Human immunodeficiency virus‐1 (HIV‐1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV‐1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretrovirals, angiotensin‐converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated.
Objectives
To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all‐cause mortality.
Search methods
We searched The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's specialised register, MEDLINE, EMBASE, AIDSearch, reference lists of articles and conference proceedings without language restrictions. We searched the international clinical trials registry platform search portal and also contacted individual researchers, research organisations and pharmaceutical companies that manufacture the drugs used for interventions.
Selection criteria
Randomised controlled trials (RCTs) and quasi‐RCTs of any therapy used in the treatment of HIVAN.
Data collection and analysis
We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. We applied the inclusion criteria to identify four relevant ongoing studies, one is ongoing while the remaining two have completed recruitment and are yet to be published. The fourth study was suspended for an unknown reason.
Main results
No completed RCTs or quasi‐RCTs were identified to be included in the study.
Authors' conclusions
There is no RCT‐based evidence upon which to base guidelines for the treatment of HIVAN. However, steroids and ACEI appear to improve the kidney function of patients in the observational studies that were identified. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.
PICOs
Plain language summary
Interventions for treating HIV‐associated nephropathy
HIV‐associated nephropathy (HIVAN) is a kidney disease common among HIV positive patients, especially patients of African origin. The condition rapidly deteriorates if left untreated. Various treatment options exist, but the benefit of each is unknown. These include: antiretrovirals, steroids, angiotensin‐converting enzyme inhibitors (ACEI) and cyclosporin. The aim of this review was to determine the benefits and harms of each treatment option. No completed randomised control trials (RCT) of any interventions for HIVAN were found and so the effects of the treatment options could not be evaluated. However, the results of observational studies identified showed that steroids and ACEI were beneficial in improving the kidney functions of patients. We await the results of three ongoing studies, however more RCTs are needed.
