World AIDS Day: Understanding the link between HIV/AIDS and kidney health

Dec. 1 is World AIDS Day, which HIV.gov describes as a reminder of the global struggle to end the stigma surrounding HIV as well as a chance to honor those lost to the disease and a call to continue working toward a day when HIV is no longer a public health threat. This annual event started 35 years ago and in honor of that anniversary, the theme for this year is "World AIDS Day 35: Remember and Commit." While progress has been made to fight HIV/AIDS, there are still ongoing challenges for people living with these diseases. One of these challenges is their increased risk of developing kidney-related complications and chronic kidney disease (CKD).

The human immunodeficiency virus (HIV) attacks and damages the immune system, which helps keep us healthy and protects us from bacteria and viruses that make us sick. When your immune system is damaged, you can get sick more easily and when you get sick, illnesses can be more severe. When HIV progresses to the later stages and severely damages your immune system, it then is considered a different condition called acquired immunodeficiency syndrome (AIDS).

HIV was first recognized in the 1980s in gay men living in Los Angeles and New York City. Scientists soon learned the most common ways to get the virus were unprotected sex, sharing needles during recreational drug use and birth. Through the 1980s and 1990s, HIV/AIDS spread rapidly and killed many people, gaining attention as an epidemic. Scientists worked quickly to create recommendations and medicines to treat and prevent the spread of HIV/AIDS. Early in the HIV/AIDS epidemic, some AIDS patients were diagnosed with HIV associated nephropathy (HIVAN). HIVAN is a type of kidney disease only found in HIV/AIDS patients. It can lead to kidney failure, which requires dialysis treatments or a kidney transplant to survive. Early diagnosis and treatment for HIV can prevent people from getting HIVAN.

Unfortunately, there is no cure for HIV/AIDS. However, in 1987, scientists created the first antiretroviral therapy (ART), a medication that keeps the amount of HIV in the blood low and allows people with HIV/AIDS to live longer and healthier lives. 

There are now several medicines and tests available to treat and detect HIV/AIDS. Unfortunately, scientists have found that certain medicines used to treat HIV/AIDS also harm the kidneys and can lead to chronic kidney disease. Today, doctors better understand why kidney damage may occur and can adjust or change medicines to keep the kidneys healthy. Doctors may also complete urine and blood tests to monitor kidney function. 

As medicines, tests and screenings have helped people with HIV/AIDS live longer, new kidney issues are being discovered, including HIV immune complex kidney disease or HIVICK. Like other immune-related kidney diseases (such as complement 3 glomerulopathy (C3G) and IgA nephropathy (IgAN)), HIVICK causes cells to attack other cells in the kidneys, leading to chronic kidney disease. 

Despite advancements in tests and treatment for the disease, HIV/AIDS is still an epidemic. According to HIV.gov, 1.2 million people in the United States are living with HIV and 13% are not aware they have it. This 13% has a higher chance of developing kidney disease if their HIV remains untreated. Furthermore, HIV affects Black and Latino Americans at higher rates than white Americans, the two populations that are also most at risk for kidney disease.

There are multiple ways to prevent HIV, including practicing abstinence (not having sex), never sharing needles and correctly using condoms every time you do have sex. You may also be able to take advantage of HIV prevention medicines such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

If you have HIV/AIDS, talk with your medical provider about steps you can take to prevent kidney disease, including regular screenings for kidney disease and following a kidney-friendly food and fluid plan.