HIV and Opportunistic Infections, Coinfections, and Conditions

The kidneys are two fist-sized organs in the body. They are located near the middle of the back on either side of the spine.

The main job of the kidneys is to filter harmful waste and extra water from the blood. The waste and water become urine, which is flushed from the body. The kidneys also release hormones that help control blood pressure, make red blood cells, and keep bones strong.

Kidney function declines as people age. Injury or disease, including HIV infection, can damage the kidneys. Damage to the kidneys can lead to kidney disease (also called renal disease). Kidney disease can advance to kidney failure known as end-stage renal disease.

Diabetes and high blood pressure are the leading causes of kidney disease. Other factors that increase the risk of kidney disease include heart disease and a family history of kidney failure.

A person's risk of kidney disease increases as they get older. The longer a person has diabetes, high blood pressure, or heart disease, the greater their risk of kidney disease.

The risk of kidney failure is especially high among African Americans, Hispanics, and American Indians, partially because these communities have high rates of diabetes and high blood pressure.

The risk factors for kidney disease in people with HIV include all those listed above. In addition, poorly controlled HIV infection and coinfection with the hepatitis C virus (HCV) increase the risk of kidney disease in people with HIV.

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV. People on ART take a combination of HIV medicines (called an HIV treatment regimen) every day. HIV medicines are recommended for everyone who has HIV. Some HIV medicines can affect the kidneys. Health care providers carefully consider the risk of kidney damage when recommending specific HIV medicines to include in an HIV treatment regimen. If a person with HIV shows signs of kidney disease, their health care provider may adjust the dose of their HIV medicines or change which HIV medicines are included in their treatment regimen.

Kidney disease can advance very slowly. Slowly worsening kidney disease is called chronic kidney disease.

As kidney disease gets worse, a person may have swelling of the legs, feet, or ankles (called edema). Symptoms of advanced chronic kidney disease can include:

• Increased or decreased urination
• Feeling tired or having trouble sleeping
• Nausea and vomiting
• Itching or numbness

Blood and urine tests are used to detect kidney disease. Care for people with HIV includes testing for kidney disease.

People with kidney disease can take steps to protect their kidneys from further damage. For example, many people with kidney disease take medicines to control high blood pressure. They may also reduce the amount of salt and protein in their diet to manage their kidney disease.

Some people live with kidney disease for many years; in others, kidney disease progresses to kidney failure. The treatments for kidney failure are dialysis and a kidney transplant. Both treatments take over the job of the failed kidneys.

• There are two main types of dialysis. Like the kidneys, both types filter harmful waste and extra water out of the blood. In hemodialysis, a machine outside of the body is used to filter the blood. In peritoneal dialysis, the lining of the abdomen filters the blood inside the body.
• A kidney transplant is surgery to place a healthy kidney from a donor into the body of a person with kidney failure. The donated kidney can be from a person who just died or from a living person.

Both dialysis and a kidney transplant are used to treat kidney failure in people with HIV.

People with HIV can take the following steps to reduce their risk of kidney disease:

• Take HIV medicines every day to keep HIV under control.
• Eat a healthy diet that includes fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Cut back on foods high in salt and sugar.
• Be physically active for 30 minutes or more on most days.
• Keep all medical appointments. During medical visits, talk to a health care provider about the risk of kidney disease.

From the Department of Health and Human Services:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV:
  • Initiation of Antiretroviral Therapy
  • HIV and the Older Person
  • Appendix B, Table 11. Antiretroviral Dosing Recommendations in Persons with Renal or Hepatic Insufficiency

From the U.S. Department of Veterans Affairs:

• Primary Care of Veterans with HIV: Renal Disease

From the National Institute of Diabetes and Digestive and Kidney Diseases:

• Your Kidneys & How They Work
• Race, Ethnicity, & Kidney Disease 
• Chronic Kidney Disease (CKD)
• Kidney Failure

Also see the HIV Source for a collection of HIV links and resources.