HIV-Associated Nephropathy in Sickle Cell Disease Patients: A Comprehensive Review

Abstract

HIV-associated nephropathy (HIVAN) is a significant cause of kidney dysfunction in HIV-infected individuals, characterized by progressive glomerular injury, proteinuria, and potentially end-stage renal disease (ESRD). When present in patients with sickle cell disease (SCD), HIVAN compounds the already existing renal challenges faced due to the vaso-occlusive nature of SCD. This review explores the pathophysiology, clinical features, diagnostic approaches, and management strategies of HIVAN in the context of SCD. It highlights the overlapping risk factors and the increased burden of kidney disease in these patients, emphasizing the importance of early detection and personalized treatment. The pathophysiology of HIVAN in SCD patients is multifactorial, involving both direct HIV-related kidney damage and the renal ischemia caused by sickle cell vaso-occlusion. The presence of both conditions accelerates kidney deterioration, with HIVAN exacerbating the renal injury caused by recurrent vaso-occlusive crises in SCD. Diagnosis is challenging due to the similarity of symptoms between sickle cell nephropathy and HIVAN, requiring a comprehensive evaluation that includes urine tests, imaging, and in some cases, renal biopsy. Differentiating between the two conditions is critical for guiding treatment strategies.