nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2021-1suppl-42-61nid-19Research ArticleПРИЛОЖЕНИЕ - ВИЧ И ХБПSUPPLEMENT - HIV AND CKDГломерулярные болезни почек при ВИЧ-инфекции: Современные представления об этиологии, классификации, патогенезеGlomerular kidney diseases in HIV-infection: Modern views on etiology, classification, pathogenesisВолгинаГ. В.VolginaG. V.volginagv@mail.ruТомилинаН. А.TomilinaN. A.noemail@neicon.ruГаджикулиеваМ. М.GadzhikulievaM. M.noemail@neicon.ruФроловаН. Ф.FrolovaN. F.noemail@neicon.ruФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова МЗ РФ»РоссияA.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова МЗ РФ»; ГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения Москвы»РоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry; Moscow City Clinical Hospital No 52Russian FederationГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения Москвы»РоссияMoscow City Clinical Hospital No 52Russian Federation2021210620242314261Copyright © Волгина Г.В., Томилина Н.А., Гаджикулиева М.М., Фролова Н.Ф., 20242024Волгина Г.В., Томилина Н.А., Гаджикулиева М.М., Фролова Н.Ф.Volgina G.V., Tomilina N.A., Gadzhikulieva M.M., Frolova N.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/19

В эпоху комбинированной антиретровирусной терапии (кAРT) ВИЧ-инфекция стала управляемым хроническим заболеванием, а не острой патологией, которая может быстро прогрессировать в синдром приобретенного иммунодефицита (СПИД). Одновременно с широким применением кАРТ распространенность заболеваний почек у людей, инфицированных вирусом иммунодефицита человека (ВИЧ-1), возросла и, как ожидается, будет расти и дальше в результате старения населения и повышения выживаемости пациентов. Несмотря на успехи в борьбе с ВИЧ-инфекцией, заболевание почек является одной из причин заболеваемости и смертности у людей, инфицированных ВИЧ. Спектр заболеваний почек, описанных в настоящее время у ВИЧ-позитивных пациентов, включает ВИЧ-ассоциированную нефропатию (ВИЧ-АН), иммунокомплексные заболевания почек в условиях ВИЧ (ВИЧ-ИКГН), тромботическую микроангиопатию и различные заболевания, связанные с нарушениями иммунной системы и суперинфекциями. ВИЧ-ассоциированная нефропатия является одной из наиболее важных причин терминальной стадии почечной недостаточности (ТПН) в этой группе населения. Такие факторы, как афроамериканское происхождение, полиморфизм APOL1, сопутствующие заболевания, высокая вирусная нагрузка, низкий уровень CD4, прогрессирующее заболевание почек и протеинурия нефротического уровня, являются факторами риска развития ВИЧ-АН и ее прогрессирования до ТПН. ВИЧ-АН характеризуется гистопатологически коллапсирующей гломерулопатией с гипертрофией и пролиферацией подоцитов, тубулоретикулярными включениями в эндотелиальных клетках, канальцевыми микрокистами и тубулоинтерстициальным инфильтратом, состоящим в основном из CD8+ T-лимфоцитов. Иммуннокомплексные гломерулярные заболевания, описанные у пациентов в условиях ВИЧ-инфекции, представляют собой группу гломерулонефритов, которые включают IgA нефропатию, волчаночно-подобный нефрит с отрицательной серологией и отсутствием других клинических проявлений волчанки, мембранозную нефропатию и мембранопролиферативный гломерулонефрит. В обзоре описаны современные тенденции развития, патофизиология, классификация и клиническая картина ВИЧ-АН и ВИЧ-ИКГН, представлен анализ литературы по заболеваниям почек, развивающихся в условиях ВИЧ-инфекции.

In the era of combined antiretroviral therapy (cART), human immunodeficiency virus (HIV) infection has become a manageable chronic disorder, rather than an acute condition that can rapidly progress to acquired immune deficiency syndrome (AIDS). Concurrent with the widespread use of cART, the prevalence of kidney disease in people infected with HIV-1 has been increasing and is expected to rise further as a result of population aging and improved patients’ survival. Despite such advances in the control of HIV-infection, kidney disease is among the causes of morbidity and mortality in human immunodeficiency virus (HIV)-1 positive individuals. A spectrum of renal diseases currently described in HIV-positive patients includes HIV-associated nephropathy (HIVAN), immunocomplex glomerular diseases in the setting of HIV (HIV-ICGD), thrombotic microangiopathy and a variety of diseases associated with abnormal immune systems and superinfections. HIV-associated nephropathy (HIV-AN) is one of the most important causes of end-stage renal disease (ESRD) in this population. Factors such as African American ancestry, APOL1 polymorphisms, comorbidities, high viral load, low CD4 count, advanced kidney disease, and nephrotic range proteinuria have been associated as risk factors for the development of HIVAN and its progression to ESRD. HIV-AN is hystopathologically characterized by collapsing focal segmental glomerulosclerosis with hypertrophy and proliferation of podocytes, tubuloreticular inclusions in endothelial cells, tubular microcysts, and tubulointerstitial infiltrate, consisting mainly of CD8+ T lymphocytes. The immunocomplex glomerular diseases described in patients in the setting of HIV-infections is a group of glomerulonephritis that includes IgA nephropathy, lupuslike nephritis with negative autoimmune serologies, and the absence of other clinical signs of lupus, membranous nephropathy, and membranoproliferative glomerulonephritis. In this review, we describe current trends in the development of HIVAN, and HIV-ICGD, pathophysiology, classification and clinical picture of diseases. An extensive review of the literature of kidney diseases developing in the context of HIV-infection has been conducted.

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The authors declare that there are no conflicts of interest present.