HIVAN is a severe kind of kidney disease that can affect people living with HIV. It’s associated with a high viral load and low CD4 count and can rapidly lead to kidney failure. Treatment involves starting or continuing antiretroviral therapy.

HIV is a virus that infects and destroys cells in the immune system. An estimated 1.2 million people in the United States have HIV.

Having HIV can increase the risk of certain health problems. One of these is kidney disease. HIV-associated nephropathy (HIVAN) is a severe type of kidney disease that can happen due to the effects of HIV. This typically only develops in severe cases.

HIVAN can progress rapidly to end stage renal disease (ESRD) without treatment. ESRD is when your kidneys can no longer work properly. ESRD requires dialysis or kidney transplantation.

Continue reading to learn about HIVAN. We cover topics like how it develops, its symptoms, treatment options, and more.

HIV can infect cells in the kidneys, but how this happens is unclear. This is because kidney cells don’t have the typical receptors that HIV interacts with to enter certain cells. There are many theories, but research is ongoing.

Once the virus is inside kidney cells, several changes may occur, such as:

  • alterations in how the kidney cells grow and divide
  • dedifferentiation, where the cells become less specialized
  • shifts in how kidney cells attach to each other and are organized
  • changes seen on biopsy, such as collapsing focal segmental sclerosis

All of this causes damage to the glomeruli and tubules in the kidneys. Glomeruli are tiny filters that help remove waste from the blood, while tubules return important substances to the blood.

When these structures are seriously damaged, the kidneys cannot work effectively.

HIVAN leads to rapid reductions in kidney function. Symptoms that indicate the kidneys may not be working well include:

High blood pressure and swelling of the legs, ankles, and feet (edema) can also happen in people with kidney disease. However, these symptoms are less common in people with HIVAN.

In addition to getting a medical history and doing a physical exam, a healthcare professional can diagnose HIVAN using several tests. These include tests for:

People with HIVAN typically have the following test results:

  • persistently high levels of protein in urine, called proteinuria
  • decreasing kidney function, indicated by decreasing eGFR and increasing serum creatinine
  • high viral load and low CD4 counts

Doctors may also perform an ultrasound to look at the size and shape of the kidneys. People with HIVAN can have kidneys that appear enlarged on an ultrasound.

Initiating or continuing antiretroviral therapy is the gold standard treatment for HIVAN.

Antiretroviral therapy prevents HIV from multiplying in the body and infecting new cells. It can help reduce the risk of HIVAN progressing to ESRD.

If you’re already receiving antiretroviral therapy, a doctor may adjust these medications during HIVAN treatment. This is because some antiretroviral therapy drugs can affect kidney function.

Some medications can also help support kidney function during recovery, including:

If someone has progressed to ESRD, dialysis can help filter the blood. Doctors may also recommend a kidney transplant for eligible candidates.

People of African descent have a higher risk of HIVAN. Experts think this is due to certain variations called G1 and G2 in the APOL1 gene that are more prevalent in this population.

Some research suggests that sex and age may also be risk factors for HIVAN. Many people who develop HIVAN are assigned male at birth and between 35 and 48 years old. However, research has yet to show a direct correlation between sex or age and the development of HIVAN.

Several other factors can increase the risk of HIVAN, including having:

People living with HIV can prevent HIVAN by taking their antiretroviral therapy as directed by a healthcare professional.

The following things can also help promote kidney health, including:

It’s also important to visit a healthcare professional for regular checkups. During these appointments, they can:

  • evaluate viral load and CD4 levels to verify that the current antiretroviral therapy plan is managing HIV
  • assess how the kidneys are working
  • check for new health conditions or see how well you are managing existing health conditions

HIVAN often happens in the later stages of HIV. It’s associated with high viral load and low CD4 count.

Generally, HIVAN is associated with a less favorable outlook. This is especially true if it remains untreated, as HIVAN can quickly progress to ESRD. The use of antiretroviral therapy can help improve survival.

The incidence of HIVAN peaked in the mid-1990s. Since then, it’s become less common due to more widespread use of antiretroviral therapy.

Is HIV-associated nephropathy the same as FSGS?

Focal segmental glomerulosclerosis (FSGS) is a characteristic of HIVAN. FSGS occurs when scarring affects the filtering units (glomeruli) of the kidney.

Do HIV medications cause nephropathy?

Yes. Some HIV medications can affect the kidneys. A few examples include atazanavir, indinavir, and tenofovir.

What symptoms are typically absent in HIV renal failure?

Symptoms like high blood pressure and edema are typically less common in people with HIVAN.

HIVAN is a severe type of kidney disease that can occur in people living with HIV. It can rapidly progress to end stage renal disease (ESRD) without treatment.

Some symptoms of kidney issues are fatigue, itchy skin, and changes in urination. Doctors diagnose HIVAN using urine and blood tests as well as imaging. Starting or continuing on antiretroviral therapy is the main treatment for HIVAN.

People with HIV can reduce their risk of HIVAN by continuing to take antiretroviral therapy as directed. It’s also important to visit a doctor for regular health checkups to ensure they’re appropriately managing HIV and any other health conditions.