Antiretroviral therapy and the kidney: balancing benefit and risk in patients with HIV infection.

The widespread introduction of highly active antiretroviral therapy (HAART) has revolutionised the treatment and course of HIV infection, with complications of chronic HIV infection and HAART playing an increasingly important role in morbidity and mortality. Both HIV infection and HAART have been associated with the development of acute and chronic kidney disease. The incidence of HIV-associated nephropathy, the classic kidney disease of HIV, reached a plateau following the introduction of HAART, consistent with the pathogenic role of direct viral infection of the kidney. At the same time, antiretroviral agents and related therapies have demonstrated a range of nephrotoxic effects, including crystal-induced obstruction, lactic acidosis, tubular toxicity, interstitial nephritis and electrolyte abnormalities. This article reviews the impact of HAART on the epidemiology of HIV-related kidney disease, the potential nephrotoxicity of specific antiretroviral agents and related medications, and guidelines for monitoring kidney function in HAART-treated patients.