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).
