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Chronic Kidney Disease in HIV-Infected Patients

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7 Î IDSA suggests a target blood pressure of <130/80 mm Hg in HIV- infected patients who have CKD with moderately to severely increased albuminuria (eg, >30-300 mg/day or equivalent) (W-L). Corticosteroids Î IDSA suggests that clinicians consider corticosteroids as an adjunct to ART and ACE inhibitors or ARBs in patients with biopsy-confirmed HIVAN (W-L). Kidney Transplantation Î IDSA recommends that HIV providers assess patients with HIV and ESRD or imminent ESRD for the possibility of kidney transplantation, considering history of opportunistic conditions, comorbidities, current immune status, and virologic control of HIV with ART (S-M). Î IDSA recommends dose adjustment and pharmacologic monitoring of immunosuppressant drugs in patients infected with HIV after kidney transplantation to account for pharmacologic interactions with antiretroviral drugs. When feasible, ART should be selected that minimizes interactions with immunosuppressant drugs (S-M). Children and Adolescents with HIV Screening Î Similar to adults, IDSA recommends that children and adolescents with HIV who are without evidence of existing kidney disease should be screened for renal function with estimated GFR (using an estimating equation developed for children) when ART is initiated or changed and at least twice yearly. IDSA recommends monitoring for kidney damage with urinalysis or a quantitative measure of proteinuria when ART is initiated or changed, and at least annually in children and adolescents with stable kidney function. More frequent monitoring may be appropriate with additional kidney disease risk factors (S-L). Î IDSA suggests avoiding tenofovir as part of first-line therapy in prepubertal children (Tanner stages 1-3) because tenofovir use is associated with increased renal tubular abnormalities and bone mineral density loss in this age group (W-L). Treatment Î IDSA recommends that children and adolescents with HIV who have proteinuric nephropathy (including HIVAN) should be treated with ART and referred to a nephrologist (S-M).

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