Effect of HAART on Incidence of HIV-Associated Nephropathy

Elissa J. Schwartz, Jonathan A. Winston, and Paul E. Klotman

Mount Sinai Medical Center, New York, NY

HIV-Associated Nephropathy (HIV AN) is the third leading cause of end stage renal disease in Blacks between the ages of 20-64. The disease is a late manifestation of HIV-1 infection. After the onset of HIV AN, patients progress rapidly to renal failure and survive only 1-2 years. Treatments for HIV AN include angiotensin-converting enzyme inhibitors or antiretroviral therapy, but controlled studies to determine the optimal therapy have been difficult due to the small number of patients and the necessity for a biopsy to confirm the HIV AN diagnosis. We sought to gain insight into the best therapeutic regimen from the epidemiology of HIV AN. Since the introduction of highly active antiretroviral therapy (HAART) in 1995, AIDS mortality has decreased and the progression to AIDS has declined. The net result has been a slowing of the overall growth rate of AIDS. Each year since 1995, the number of new cases of HIV AN has also decreased. This suggests that HAART may have reduced the incidence of HIV AN as well. Using a simple mathematical model of HIV AN population dynamics, we examined whether the introduction of HAART explains the decrease in HIV AN incidence. The results of the model suggest that HAART caused both a reduction in the AIDS growth rate and a decrease in the incidence of HIV AN in AIDS patients. This indicates that HAART is likely to be effective therapy for patients at risk for the development of HIV AN.