The widespread introduction of
highly active antiretroviral therapy (
HAART) has revolutionised the treatment and course of
HIV infection, with complications of chronic
HIV infection and
HAART playing an increasingly important role in morbidity and mortality. Both
HIV infection and
HAART have been associated with the development of acute and
chronic kidney disease. The incidence of
HIV-associated nephropathy, the classic
kidney disease of HIV, reached a plateau following the introduction of
HAART, consistent with the pathogenic role of direct
viral infection of the kidney. At the same time,
antiretroviral agents and related
therapies have demonstrated a range of nephrotoxic effects, including crystal-induced obstruction,
lactic acidosis, tubular toxicity,
interstitial nephritis and
electrolyte abnormalities. This article reviews the impact of
HAART on the epidemiology of HIV-related
kidney disease, the potential nephrotoxicity of specific
antiretroviral agents and related medications, and guidelines for monitoring kidney function in
HAART-treated patients.