• The Human Immunodeficiency Virus (HIV) is best known for weakening the immune system, but it can also silently damage another vital organ, the kidneys. Over the years, HIV-associated kidney disease (HIVAN) has become one of the significant causes of chronic kidney disease (CKD), particularly among patients who start treatment late or experience long-term effects of antiretroviral therapy (ART).

How HIV Affects the Kidneys

HIV can harm the kidneys in several ways. The virus may directly infect kidney cells, trigger immune-related inflammation, or cause injury through certain medications used to control HIV. These processes can lead to different kidney disorders such as focal segmental glomerulosclerosis (FSGS), immune complex disease, and tubulointerstitial nephritis.

As a result, many people with HIV develop gradual loss of kidney function. If not treated on time, this can progress to end-stage kidney disease (ESKD), a stage where dialysis or a kidney transplant becomes the only option.

With the success of ART programs like the National AIDS Control Organisation (NACO) initiative, people with HIV are now living longer and healthier lives. However, this improved longevity means chronic diseases such as CKD are emerging as new health priorities.

Early detection remains key. Routine testing for urine protein (albumin) and kidney function (creatinine and eGFR) is essential to identify early kidney changes and prevent irreversible damage.

Management of ESRD in HIV Patients

For HIV-positive individuals who progress to end-stage renal disease (ESRD), renal replacement therapy (RRT) is essential to sustain life. With proper infection control and ART management, both dialysis and transplantation can be safely offered.

1. Maintenance Hemodialysis (MHD)

MHD remains the most common form of renal replacement therapy in HIV-positive patients.

2. Peritoneal Dialysis (CAPD/APD)

Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) are excellent home-based alternatives, especially for patients with stable HIV and good hygiene practices.

3. Integration with ART

●     Coordination between nephrologists and infectious disease specialists ensures optimal outcomes.

Can HIV-Positive Patients Receive Kidney Transplants?

While kidney transplantation for HIV-positive patients is still limited to select centers in India, outcomes have been encouraging, with graft and patient survival rates comparable to HIV-negative recipients.

Managing Life After Transplant

Post-transplant management is more complex in HIV-positive patients because some ART drugs interact with immunosuppressants. Experienced multidisciplinary teams, nephrologists, infectious disease specialists, and transplant physicians, play a crucial role in adjusting doses and preventing complications.

Preventive medications and vaccinations (against hepatitis, influenza, pneumococcus, and tuberculosis) are strongly recommended before transplant to reduce infection risk.

HIV-related kidney disease is a growing yet manageable concern in India. Early screening, appropriate ART, and regular follow-up can prevent most complications. For those who develop advanced kidney failure, transplantation now offers a safe and effective path to recovery.

With increasing awareness and specialized care, HIV no longer needs to be a barrier to living a healthy, fulfilling life, even after kidney disease.

Dr. Gandhe Sridhar

Sr. Consultant, Nephrology & Transplant Physician | Director - Nephrology & Transplant

STAR Hospitals  Hyderabad.