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首页> 外文期刊>Journal of Clinical Medicine Research >HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention
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HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention

机译：非洲与艾滋病毒有关的肾病：病理，临床表现和预防策略

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The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms “HIVAN” and “pathology and clinical presentation”, in addition to “prevalence and risk factors for HIVAN”, with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/μL. Other clinical presentations in African populations include acute kidney injury, nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN.J Clin Med Res. 2018;10(1):1-8doi: https://doi.org/10.14740/jocmr3235w
机译：人类免疫缺陷病毒（HIV）感染可导致肾功能逐渐下降，这被称为HIV相关性肾病（HIVAN）。重要的是，非洲血统的人比欧洲血统的人更容易患上HIVAN。除“ HIVAN的患病率和危险因素”外，还使用“ HIVAN”和“病理学和临床表现”等术语对Google Scholar，Medline和PubMed进行了深入搜索，其中特别着重非洲国家从1990年至2017年。HIVAN的特征是进行性急性肾衰竭，蛋白尿和肾脏肿大。肾活检对确定诊断至关重要。危险因素是男性，低CD4计数，高病毒载量和长期使用抗逆转录病毒药物（cART）。 HIVAN的流行范围在全球范围内差异很大，范围从4.7％到38％不等，关于其在非洲国家中的流行情况的公开文献很少。微量白蛋白尿在非洲人群中很常见，并且与HIV疾病进展的严重程度和CD4计数低于350细胞/μL密切相关。非洲人群的其他临床表现包括急性肾损伤，肾病综合征和慢性肾脏疾病。与HIV相关的主要肾脏病理病变为局灶性节段性肾小球硬化，主要为塌陷型，急性间质性肾炎（AIN）和免疫复合物介导的肾小球肾炎（ICGN）。 HIVAN的发病机理与HIV感染引起的肾小管上皮细胞转录程序以及遗传因素有关。这篇叙述性评论讨论了非洲HIVAN的流行，表现，发病机制和管理。在非洲资源贫乏的国家，与HIV药物本身相比，处理HIVAN等HIV并发症可能会给卫生系统（尤其是肾脏单位）增加更多负担。因此，明显的建议是尽早使用cART，以减少导致HIVAN的危险因素。 2018; 10（1）：1-8doi：https://doi.org/10.14740/jocmr3235w

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