Inhibition of the Renin-Angiotensin System in HIV nephropathy

It is estimated that 1-2 % of patients starting dialysis suffers from kidney disease associated with HIV infection. HIV-associated nephropathy ( HIVAN ) develops in about 10% of people living with HIV , with different preference for Blacks and Hispanics . Since the beginning of large-scale use of antiretroviral therapy (ART), the HIVAN has been characterized by a rapid decline in renal function , with progression to ESRD ( End - Stage Renal Disease ). Aside from HIV direct damage to the nephron, numerous experimental observations support the argument that the agiotensina II contributes to the podocytes damage. Treatment with ACE - inhibitors (ACE - Is) , as well as the one with angiotensin receptor blockers ( ARBs), may attenuate the decline in renal function in HIVAN . However, clinical data on the effects of these antihypertensive agents in HIV-infected individuals are still scarce and doubts have yet to be adequately addressed. In the following, we analyze the studies that have investigated the use of ACE -Is and ARBs in the treatment of hypertension and albuminuria in patients with HIVAN.