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How to reduce your risk for kidney disease if you’re living with HIV

As patients age, managing the infection becomes more complex

Dr Bertrand Lebouché is an HIV primary care specialist, an assistant professor and a clinician.

An estimated 63,110 people in Canada are living with HIV — the majority are gay and bisexual men. Today, thanks to advances in care and medication, many patients are achieving an undetectable level of the virus and are now able to live longer and healthier lives. However, as HIV-positive people age, doctors are discovering more about the virus’s impact on the body, including an increase in other health risks such as kidney disease.

Dr Bertrand Lebouché is an HIV primary care specialist, an assistant professor in the Department of Family Medicine at McGill University, and a clinician at the Chronic Viral Illness Service at the McGill University Health Centre. Here are his recommendations for protecting kidney health.

What do we now know about living a healthy life while HIV-positive that we didn’t know before? 

Thanks to the success of science and medicine, most people are living well with HIV. Today, with early diagnosis and effective treatment, a 20-year-old HIV-positive person can expect to live into their early 70s — a life expectancy very close to that of the general population. In Canada, the majority of people living with HIV are now over the age of 50.

In most cases of HIV, people have undetectable viral loads, meaning that the virus is blocked in their body and they have no risk of transmitting it to others. Care for people living with HIV is evolving, with an increasing focus on dealing with age-related health risks.

What is the relationship between HIV and kidney disease? 

As we age, the body’s organs will sometimes work less efficiently — for the kidneys, it becomes more difficult to filter blood, waste and drugs. It’s almost like HIV can accelerate the aging process.

When you live with HIV, your risk of having kidney problems is nearly 10 times higher than those living without the virus. Inflammation provoked by HIV can have a negative impact on the kidneys — which is why it’s very important to do frequent testing. If HIV is detected early, your kidneys won’t be attacked for as prolonged a period, and we know that inflammation is greatly reduced when people are able to get and keep their viral loads undetectable over the long-term.

Exposure to certain HIV medications is also linked to kidney damage. Some HIV treatments have shown to have virtually no impact on kidneys, as compared to older treatments. “It’s important to speak with your physician.”

Cardiovascular issues that are commonly associated with having HIV are also more likely to be associated with kidney problems. For example, people living with the virus often have high blood pressure, diabetes, metabolic abnormalities or are overweight or obese.

How can people become better aware of the health of their kidneys? 

All people living with HIV should be screened for kidney disease at their initial diagnosis. Those at high risk of kidney impairment should be checked every year — or more regularly depending on your treatment regimen — even if kidney function appears normal. Your doctor can also test blood pressure, check protein levels in a urine sample and measure the amount of creatinine with a blood test. With just these three tests, a clinician will know a lot about your kidney function.

How can we prevent kidney disease? 

It’s important to control blood pressure and blood glucose. Avoid smoking and limit the intake of drugs and alcohol. You also need to be careful with over the counter medications: anti-inflammatories can be toxic for the kidneys, as can protein supplements. Another big thing is to treat and cure Hepatitis C infection because it can increase the risk of kidney disease.

Why is it important to talk about this now? 

As we contemplate the future of HIV, the goal is for all patients to achieve long-term undetectable HIV load and stay on top of additional health problems. In the next decade, almost three quarters of the HIV-positive population will be over the age of 50. Aging with HIV can bring a new set of challenges as an increasing number of patients will need treatment for age-related comorbidities, or additional chronic diseases, possibly related to their medications. We have very good HIV treatments now which can help us avoid kidney toxicity, but it’s always a good time to be extra vigilant with your health.