Is there a treatment for HIVAN or HIVICK?
Successful therapy of any kidney disease is dependent on the degree of reversible or irreversible lesions that are present.
The most important predictor of response to therapy is the degree of interstitial fibrosis, which can only be ascertained from a kidney biopsy. HIVAN is considered a treatable and potentially reversible disease if diagnosed at an early stage. Because HIVAN is a result of the direct infection of kidney tissue and the gene products of the HIV genome, eradication of active viremia improves kidney function.
cART reverses glomerular and tubular lesions, and patients achieve remission of proteinuria and improved kidney function.
This benefit lasts only as long as viremia is controlled, and relapses with the discontinuation of cART and a resurgence of viremia.
Although HIVICK lesions also result from active HIV infection, they do not appear equally responsive to cART therapy. HIVICK-mediated immune complex injury more commonly causes permanent kidney damage, and, unlike HIVAN, complete histologic reversal is not seen.
In addition to cART, short-term steroid therapy may have a role in patients with significant interstitial infiltrates on biopsy. Steroids do not affect the collapsing glomerular lesion of FSGS, but they do reduce the inflammatory cytokine production in the interstitium, and can improve kidney function while cART is initiated. Steroids have not been shown to be effective in HIVICK, most likely because of the lack of a significant component of interstitial nephritis in these patients.
Adjunctive therapy for nephrotic syndrome with inhibitors of the renin-angiotensin system—angiotensin-converting enzyme inhibitors and angiotensin receptor blockers—are effective in reducing proteinuria and delaying the progression of kidney disease in HIVAN. These agents can be used at the time of diagnosis but are not considered to be first-line therapy. The most important initial treatment for HIVAN and HIVICK is cART.
