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de alto riesgo no infectados por el VIH (27)

      Recomendaciones

      1.El diagnóstico es clínico mediante el estadiaje según la tasa de filtración glomerular y el resultado de la biopsia renal en el caso de sospecha de NIVIH.

      2.Se debe cambiar TDF por TAF si la tasa de filtración disminuye un 25% o la tasa de filtración glomerular es menor a 60 ml/min/1,73 m2.

      3.Recomendamos que se tome en cuenta el ajuste de la dosis de los ARV según la eGFR detallada en la versión 10.0 de las guías clínicas de la European AIDS Clinical Society.

      4.Se deben tomar en cuenta otros factores para el desarrollo de enfermedad renal en los PVVS y además deben ser controlados (dislipidemia, diabetes mellitus, entre otros).

      5.En el caso de que amerite, se debe ajustar la dosis de los ARV a la tasa de filtrado glomerular.

      6.Los IECA y BRA están indicados en el manejo de la NIVIH.

      7.No se recomienda el uso de corticoides en la NIVIH de forma rutinaria.

      8.La atención de los pacientes con NIVIH debe compartirse con un nefrólogo o alguien con experiencia en el manejo de pacientes con enfermedad renal.

      BIBLIOGRAFÍA

      1.Wyatt CM, Arons RR, Klotman PE, Klotman ME. Acute renal failure in hospitalized patients with HIV: risk factors and impact on in-hospital mortality. AIDS [Internet]. 2006;20(4):561–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16470120

      2.Roe J, Campbell LJ, Ibrahim F, Hendry BM, Post FA. HIV Care and the Incidence of Acute Renal Failure. Clin Infect Dis [Internet]. 2008;47(2):242–9. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1086/589296

      3.Li Y, Shlipak MG, Grunfeld C, Choi AI. Incidence and risk factors for acute kidney injury in HIV infection. Am J Nephrol. 2012;35(4):327–34.

      4.Franceschini N, Napravnik S, Eron JJ, Szczech LA, Finn WF. Incidence and etiology of acute renal failure among ambulatory HIV-infected patients. Kidney Int. 2005;67(4):1526–31.

      5.Ryom L, Mocroft A, Kirk O, Worm SW, Kamara DA, Reiss P, et al. Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: The D:A:D Studya. J Infect Dis. 2013;207(9):1359–69.

      6.Scherzer R, Estrella M, Li Y, Deeks SG, Grunfeld C, Shlipak MG, et al. Association of Tenofovir Exposure with Kidney Disease Risk in HIV Infection. Aids. 2012;26(7):867–75.

      7.Sax PE, Wohl D, Yin MT, Post F, DeJesus E, Saag M, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate, coformulated with elvitegravir, cobicistat, and emtricitabine, for initial treatment of HIV-1 infection: Two randomised, double-blind, phase 3, non-inferiority trials. Lancet [Internet]. 2015;385(9987):2606–15. Available from: http://dx.doi.org/10.1016/S0140-6736(15)60616-X

      8.Nelson MR, Katlama C, Montaner JS, Cooper DA, Gazzard B, Clotet B, et al. The Safety of Tenofovir Disoproxil Fumarate for the Treatment of HIV Infection in Adults: The first 4 years. Aids [Internet]. 2007;21(10):1273–81. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-34249984379&partnerID=40&md5=651b06e05bdc22c7ae263a17a2d12a08

      9.Fraser TN, Avellaneda AA, Graviss EA, Musher DM. Acute kidney injury associated with trimethoprim/sulfamethoxazole. J Antimicrob Chemother. 2012;67(5):1271–7.

      10.German P, Liu HC, Szwarcberg J, Hepner M, Andrews J, Kearney BP, et al. Effect of Cobicistat on Glomerular Filtration Rate in Subjects With Normal and Impaired Renal Function. JAIDS J Acquir Immune Defic Syndr [Internet]. 2012;61(1):32–40. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00126334-201209010-00005

      11.Koteff J, Borland J, Chen S, Song I, Peppercorn A, Koshiba T, et al. A phase 1 study to evaluate the effect of dolutegravir on renal function via measurement of iohexol and para-aminohippurate clearance in healthy subjects. Br J Clin Pharmacol. 2013;75(4):990–6.

      12.Of E, Report C. of a R Enal R Eservoir of Hiv. 2001;344(26):1–6.

      13.Laurinavicius A, Hurwitz S, Rennke HG. Collapsing glomerulopathy in HIV and non-HIV patients: A clinicopathological and follow-up study. Kidney Int. 1999;56(6):2203–13.

      14.Kopp JB, Klotman ME, Adler SH, Bruggeman LA, Dickie P, Marinos NJ, et al. Progressive glomerulosclerosis and enhanced renal accumulation of basement membrane components in mice transgenic for human immunodeficiency virus type 1 genes. Proc Natl Acad Sci U S A [Internet]. 1992;89(5):1577–81. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=48495&tool=pmcentrez&rendertype=abstract

      15.Bruggeman LA, Ross MD, Tanji N, Cara A, Dikman S, Gordon RE, et al. Renal epithelium is a previously unrecognized site of HIV-1 infection. J Am Soc Nephrol [Internet]. 2000;11(11):2079–87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11053484%5Cnhttp://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=11053484&retmode=ref&cmd=prlinks%5Cnpapers3://publication/uuid/2C708486-F419-452C-9E45-17230B6DEA2B

      16.Hays T, Wyatt CM. APOL1 variants in HIV-associated nephropathy: Just one piece of the puzzle. Kidney Int [Internet]. 2012;82(3):259–60. Available from: http://dx.doi.org/10.1038/ki.2012.129

      17.Lucas GM, Eustace J a, Sozio S, Mentari EK, Appiah K a, Moore RD. Highly active antiretroviral therapy and the incidence of HIV-1-associated nephropathy: a 12-year cohort study. AIDS. 2004;18(3):541–6.

      18.Han TM, Naicker S, Ramdial PK, Assounga AG. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa. Kidney Int [Internet]. 2006;69(12):2243–50. Available from: http://dx.doi.org/10.1038/sj.ki.5000339

      19.Bigé N, Lanternier F, Viard JP, Kamgang P, Daugas E, Elie C, et al. Presentation of HIV-associated nephropathy and outcome in HAART-treated patients. Nephrol Dial Transplant. 2012;27(3):1114–21.

      20.Plwh ART. Version 10.0 November 2019. 2019;(November):0–122.

      21.Atta MG, Choi MJ, Longenecker JC, Haymart M, Wu J, Nagajothi N, et al. Erratum: Nephrotic range proteinuria and CD4 count as non-invasive indicators of HIV-associated nephropathy (American Journal of Medicine (2005) 118 (1288-1289)). Am J Med. 2006;119(2):191.

      22.Lucas GM, Ross MJ, Stock PG, Shlipak MG, Wyatt CM, Gupta SK, et al. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV medicine association of the infectious diseases society of America. Clin Infect Dis. 2014;59(9):e96–138.

      23.Yahaya I, Uthman OA, Uthman MMB. Interventions for HIV-associated nephropathy. Cochrane Database Syst Rev [Internet]. 2013;(1):CD007183. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23440812%0Ahttp://doi.wiley.com/10.1002/14651858.CD007183.pub3

      24.Burns GC, Paul SK, Toth IR, Sivak SL. Effect of angiotensin-converting enzyme inhibition in HIV-associated nephropathy. J Am Soc Nephrol. 1997;8(7):1140–6.

      25.Eustace JA, Nuermberger E, Choi M, Scheel J, Moore R, Briggs WA. Cohort study of the treatment of severe HIV-associated nephropathy with corticosteroids. Kidney Int. 2000;58(3):1253–60.

      26.Smith MC, Austen JL, Carey JT, Emancipator SN, Herbener T, Gripshover B, et al. Prednisone improves renal function and proteinuria in human immunodeficiency virus-associated nephropathy. Am J Med. 1996;101(1):41–8.

      27.Zheng X, Gong L, Xue W, Zeng S, Xu Y, Zhang Y, et al. Kidney transplant outcomes in HIV-positive patients: A systematic review and meta-analysis [Internet]. Vol. 16, AIDS Research and Therapy. BioMed Central; 2019. 1–32 p. Available from: https://doi.org/10.1186/s12981-019-0253-z

       METABOLISMO ÓSEO Y VIH

      Autoras: Dra. Rosa Terán Terán, Dra. Kathya Verónica Suaste Pazmiño

      La disminución de la densidad mineral ósea (DMO) y el desarrollo de osteoporosis observadas en las PVVS, comparada con controles sanos, incrementa el riesgo de fracturas y con ello una

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