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- General: Treatment generally involves aggressive highly active antiretroviral therapy (HAART), which suppresses HIV and has been shown to improve kidney function. Corticosteroids may also be used to improve kidney function. Kidney dialysis and/or transplantation may be necessary in cases of severe damage. If the patient is taking antiretrovirals known to cause kidney damage, a healthcare provider may recommend altering the medication or dose.
- Altering HIV treatment: If the patient is taking antiretrovirals known to cause kidney damage, a healthcare provider may recommend altering the medication or dose.
- Corticosteroids: Corticosteroids like prednisone (Deltasone ®, Orasone ®, or Meticorten ®) may significantly improve kidney function in some patients with HIVAN. Patients typically receive daily doses of corticosteroids for two to 11 weeks. In order to avoid symptoms of withdrawal, patients should not suddenly stop treatment without talking to their healthcare providers. Instead, patients should slowly taper off the medication under the supervision of their healthcare providers.
- Highly active antiretroviral therapy (HAART): Highly active antiretroviral therapy (HAART) is a combination of anti–HIV drugs (antiretrovirals) that helps suppress the virus in the body. HAART therapy has been shown to slow the progression of kidney disease in HIVAN patients.
- Patients receive a combination of drugs from at least two of the four major classes. The four major classes are: fusion inhibitors, protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), and non–nucleoside reverse transcriptase inhibitors (NNRTIs). Each class of drugs interferes with a different stage of HIV's replication process.
- Most HIV medications are well tolerated, even if the patient has kidney disease. However, patients may need to receive alternative doses of some antiretrovirals, especially non–nucleoside reverse transcriptase inhibitors and protease inhibitors.
- Kidney dialysis: In cases of severe kidney damage or kidney failure, dialysis may be administered. Dialysis is a method of removing toxic substances and waste from the blood because dysfunctional kidneys are unable to perform this function. During the procedure, a hollow tube, called a catheter, is inserted into a patient's vein at the hospital. The blood is then filtered through a dialysis machine to remove waste products from the blood. The filtered blood is then returned to the patient. This procedure typically lasts about three to four hours. In general, patients with kidney failure undergo dialysis about three times a week.
- Kidney transplant: Some patients with HIVAN may develop kidney failure. When this happens, the kidneys, which are vital for daily living, are no longer able to function properly. Kidney failure is fatal without a kidney transplant. Since individuals can function with just one kidney, only one kidney must be transplanted into the patient.
- After the kidney transplant, patients will need to take drugs called immunosuppressants for the rest of their lives in order to prevent their bodies from attacking the transplanted organs. The most commonly prescribed oral immunosuppressants include tacrolimus (Prograf ®), mycophenolate mofetil (CellCep ®t), sirolimus (Rapamune ®), prednisone (Prednisone Intensol ®), cyclosoporine (Neoral ®, Sandimmune ® or Gengraf ®), and azathioprine (Imuran ®). In general, patients are typically prescribed two to three medications for long–term immunosuppression.
- Also, since kidney transplant recipients have only one functioning kidney after surgery, they will need to alter their diets so the kidney is not overworked. For instance, alcohol and caffeine should be avoided because these products contain many toxins and wastes that are difficult for just one kidney to filter from the blood.
- However, not all kidney failure patients are suitable candidates for kidney transplantation. The transplant must come from a donor whose body tissues are a close biological match to the recipient. The donated kidney may come from a living relative who is a match or from a deceased donor. In order to receive an organ from a deceased donor, patients are added to a national waiting list. There is no way to know how long a patient will wait. Some will wait weeks, while others may wait years. It is estimated that 18 people on the organ transplant waiting list die each day.
- Until recently, people who had HIV were not considered suitable candidates for organ transplantations. Many patients were denied transplants under the assumption that they had shorter life expectancies and less favorable survival rates than other patients in need of transplants. However, now that patients are living longer lives, many groups are reconsidering whether HIV patients should be transplant candidates. Although the United Network for Organ Sharing (UNOS) does not consider HIV infection a contraindication for organ transplantation, the decision to perform transplantation in an HIV–positive individual varies according to policies at individual centers. Some centers will not provide organ transplants to good candidates who are HIV–positive.
- As with any major surgery, serious health risks are associated with the kidney transplantation. Individuals who have weakened immune systems are at risk of developing graft–versus–host disease after surgery. This condition occurs when the transplanted organ attacks the recipient's weakened immune system. Other recipients may experience transplant rejection, which occurs when the body's immune system attacks the donated organ.
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