Increased blood pressure (hypertension)

Hypertension, or high blood pressure, is a leading cause of kidney disease. It can also be a sign that kidney health is already impaired. Hypertension can damage the small blood vessels in the kidneys and, in turn, prevent them from properly filtering waste.

It's still not clear if HIV-positive people are more likely to suffer from high blood pressure than their HIV-negative counterparts. However, there's little data to suggest that they are less likely to experience it. And with HIV-positive people living longer, thanks to the widespread use of ARV treatment, non-HIV health problems like hypertension become increasingly likely.

It's worth noting that blacks make up 49 percent of the HIV/AIDS cases in the United States And among blacks 20 and older, regardless of HIV status, about 43 percent of men and 47 percent of women have high blood pressure.

Among Latinos, who make up 18 percent of the HIV/AIDS epidemic in the United States, one study documented high blood pressure in 29 percent of the men and 31 percent of the women of Mexican descent.
 

Diabetes

Diabetes is a disease that prevents the body from breaking down glucose (sugar) correctly. This causes glucose levels to remain high in the bloodstream and ultimately damage the nephrons in the kidneys. This can lead to a condition called diabetic nephropathy, a very common form of kidney disease.

HIV-positive people, especially those on protease inhibitor therapy, are at an increased risk of glucose-related problems. In a 2004 report published by the Multicenter AIDS Cohort Study, HIV-positive men on ARV therapy were three times more likely to be diagnosed with diabetes over a four-year period, compared with HIV-negative men.

It's also worth noting that blacks and Latinos are nearly two times more likely to have diabetes than whites of similar age. This increases their chance of developing complications like chronic kidney disease.
 

HIV-associated nephropathy (HIVAN)

A handful of diseases can attack the tiny blood vessels in the kidneys, a notable one being HIV-associated nephropathy (HIVAN). It's caused by HIV infection of the kidneys, which can damage the lining of the glomeruli and tubules. Left untreated, it can lead to ESRD in six to 12 months.

While it's not really clear how many HIV-positive people suffer from HIVAN, it usually occurs among black men. Low CD4 cell counts and a family history of renal disease are also risk factors for HIVAN.

HIV treatment can used effectively to prevent and treat HIVAN.
 

Medications

A small number of medications, including those used by HIV-positive people, list acute renal failure (ARF) as a possible side effect. Experts advise HIV-positive patients with a history of ARF or chronic kidney disease (CKD) to use these drugs with caution—and to have a health care provider adjust the doses.

• Medications for opportunistic infections (OIs). Some meds used to treat fungal infections, Pneumocystis pneumonia (PCP) and cytomegalovirus (CMV) are known to rapidly shut down the kidneys in some patients.
• HIV medications. The protease inhibitors Crixivan (indinavir) and less frequently Reyataz (atazanavir) can cause kidney stones. Nucleoside reverse transcriptase inhibitors (NRTIs), notably Zerit (stavudine) and Videx/Videx EC (didanosine), have been known to cause a buildup of acid (lactic acidosis) in the blood that can lead to kidney failure and other serious problems.
  
  Another member of the NRTI class that can cause kidney problems is tenofovir, the active ingredient in Viread and one of the drugs in Truvada, Atripla and Complera. Tenofovir can accumulate in the kidney tubules, effectively blocking their function. Fortunately, rates of renal failure have been quite low, on the order of 0.5 to 1.5 percent of tenofovir takers. 
• Pain medications. NSAIDS, such as over-the-counter Advil (ibuprofen) and Aleve (naproxen), are frequently recommended and used to relieve pain. In some people they can cause an allergic reaction known as interstitial nephritis, which can decrease blood flow inside the kidneys.
• Herbal therapies. Finally, some herbal therapies—notably those containing aristolochic acid (found in the flowering plant Dutchman's pipe, formally called Aristolochia)—have been shown to cause kidney damage and may be responsible for some cancers in the urinary tract. In fact, the U.S. Food and Drug Administration recommends that people do not take herbal therapies containing aristolochic acid—including products with the words "Aristolochia," "Bragantia" or "Asarum" listed as ingredients on the label. Click here for a partial list of products to avoid.

This content is written by the editorial team at AIDSmeds.com.
Please find profiles of this team on our "About Us" page.