HIV and Chronic Kidney Disease: What You Need to Know

HIV (human immunodeficiency virus) is a virus that infects and damages your immune system. Your immune system helps your body defend itself against infection and other disease. HIV attacks and destroys the disease-fighting cells of your immune system and leaves your body weak against infection and cancer.

Having HIV does not mean that you have AIDS (acquired immune deficiency syndrome). However, HIV can lead to AIDS if left untreated. AIDS is the most serious and advanced stage of HIV infection.

Having HIV may put you at risk for getting kidney disease. In fact, it is not unusual for people with HIV to develop kidney disease.

If you have HIV, your chances of getting kidney disease are even greater if you:

• Have a high viral load (a large amount of HIV in the blood).
• Have a low CD4 count ( a low number of the blood cells that help fight disease such as HIV)
• Are African American, Hispanic American, Asian, Pacific Islander or American Indian
• Have diabetes, high blood pressure or Hepatitis C
• Have a family member who has kidney disease
• Are 65 or older
• Have used medications over the course of many years that damage the kidneys (such as NSAIDs and other pain killers).

This happens because:

• HIV can harm the nephrons (filters) in your kidneys. When this happens, the filters do not work as well as they should.
• HIV can infect the cells in your kidneys
• If not carefully monitored, some of the medicines used to treat HIV can harm the nephrons in your kidneys.

Learn more about your kidneys and why are they important.

Learn more about kidney disease stages.

Most people with early kidney disease do not have symptoms. The best way to find out is to be tested for it. There are two simple tests to check for kidney disease.

1. Urine Test called ACR. ACR stands for "albumin-to-creatinine ratio." Your urine will be tested for albumin. Albumin is a type of protein. Your body needs protein. However, it should be in the blood, not the urine. Having protein in your urine may mean that your kidneys are not filtering your blood well enough. This can be a sign of early kidney disease. If your urine test comes back "positive" for protein, the test should be repeated to confirm the results. Three positive results over three months or more is a sign of kidney disease.
2. Blood Test to estimate your GFR. Your blood will be tested for a waste product called creatinine. Creatinine comes from muscle tissue. When the kidneys are damaged, they have trouble removing creatinine from your blood. Testing for creatinine is only the first step. Next, your creatinine result is used in a math formula with your age, race, and sex to find out your glomerular filtration rate (GFR). Your GFR number tells your healthcare provider how well your kidneys are working.

Everyone with HIV should be tested for kidney disease at least once. This should be done when you first learn you have HIV. Ask your health care provider if you were ever tested for kidney disease; if not, get tested. People with HIV who have additional risk factors for kidney disease will need to be tested at least once a year.

Yes, it is possible for people with HIV to have a kidney transplant. All candidates for a kidney transplant need to undergo a thorough medical exam before being an active candidate on the kidney transplant waitlist. HIV patients must have an undetectable viral load and a CD4 count over 200 to be considered for a transplant. Maintaining your CD4 count over 200 and have as low of viral load as possible is important. After receiving a kidney transplant, patients need to take medications that suppress their immune system for the life of the kidney transplant.

Yes, a person with HIV can donate a kidney to someone who is HIV positive. On November 21, 2013, the HOPE Act (HIV Organ Policy Equity Act) was signed into law. This law allows people with HIV to register as organ donors. People with HIV on the transplant wait list at approved centers can choose to accept these organs. (In other words, organs from HIV-positive donors are only offered to HIV-positive transplant candidates.) The transplant center will look at the deceased donor's CD4 counts and HIV viral loads, but there is no absolute threshold for either.

The HOPE Act also allows people with HIV to be living donors. To become an HIV-positive living donor, you must:

• Meet all requirements of the transplant center
• Have an undetectable viral load and a CD4 count over 500
• Have no prior history of an invasive infection, such as PCP pneumonia or active fungal meningitis
• Undergo a kidney biopsy

Learn more from UNOS.org: The Hope Act

Find a participating transplant center: Dept of Health and Human Resources

Many people with HIV do not get kidney disease or kidney failure. Talk to your health care provider about your chances of getting kidney disease. If you have HIV, you can lower your chances by:

• Checking your blood pressure as often as your doctor recommends and taking steps to keep it under control
• Taking all your HIV medications as prescribed
• Asking your doctor about HIV drugs that have a lower risk of causing kidney damage
• Controlling your blood sugar if you have diabetes
• Taking medicines to control your blood glucose, cholesterol, anemia, and blood pressure if your doctor orders them for you
• Asking your doctor to test you for kidney disease at least once each year if you:
  • Have a large amount of HIV in your blood
  • Have a low level of blood cells that help fight HIV (CD4 cells)
  • Are African American, Hispanic American, Asian, Pacific Islander, or American Indian
  • Have diabetes, high blood pressure, or hepatitis C

HIV can cause kidney problems that may become serious. Kidney problems do not really show up as symptoms of disease. It is important to follow your medical routine as carefully as possible and talk to your doctor about getting tested for kidney disease.