Renal failure in HIV-infected patient

Renal failure is common in human immunodeficiency virus (HIV)-infected patients admitted to the intensive care unit (ICU). Improved life expectancy in patients receiving combination antiretroviral therapy (cART) is associated with an increasing prevalence of chronic kidney diseases (CKD) in this population, as a result of extended exposure to comorbidities that may impair renal function (including hepatic and cardiovascular diseases) and late nephrotoxic effects of certain cART regimen. Meanwhile, a decreasing trend is observed in the incidence of HIV-associated nephropathy (HIVAN) and other kidney diseases directly related to HIV infection or the acquired immunodeficiency syndrome. Acute renal failure (ARF) is present upon admission or occurs during the ICU stay in one to two-thirds of patients, and significantly increases the risk of ICU death and subsequent progression to CKD. Sepsis and exposure to nephrotoxic drugs are the main causes of ARF in this context. Renal biopsy should be discussed in each ARF episode when noninvasive methods failed to identify the underlying nephropathy. Lastly, since published data are dramatically lacking, the management of cART remains challenging in critically ill patients with altered renal function. This crucial aspect of intensive care in HIV-infected patients should be the focus of further prospective works.