Four decades after the first cases of HIV were reported, kidney disease remains an important comorbidity in people with HIV (PWH). Both HIV-associated nephropathy and immune complex kidney disease were recognized as complications of HIV infection in the early years before treatment was available. Although the introduction of effective antiretroviral therapy in the late 1990s resulted in dramatic improvements in survival and health in PWH, several commonly used antiretroviral agents have been associated with kidney injury. HIV infection and treatment may also promote the progression of comorbid chronic kidney disease due to traditional risk factors such as diabetes, and HIV is one of the strongest “second hits” for the high-risk APOL1 genotype. Unique considerations in the management of chronic kidney disease in PWH are largely related to the need for lifelong antiretroviral therapy, with potential for toxicity, drug–drug interactions, and polypharmacy. PWH who develop progressive chronic kidney disease are candidates for all modalities of kidney replacement therapy, including kidney transplantation, and at some centers, PWH may be candidates to serve as donors for recipients with HIV. Transplantation of kidney allografts from donors with HIV also offers a unique opportunity to study viral dynamics in the kidney, with implications for kidney health and for research toward HIV cure. In addition, HIV-transgenic animal models have provided important insights into kidney disease pathogenesis beyond HIV, and experience with HIV and HIV-related kidney disease has provided important lessons for future pandemics.

在报告第一例艾滋病毒病例四十年后，肾脏疾病仍然是艾滋病毒感染者 (PWH) 的一个重要合并症。在治疗出现之前的早期，艾滋病毒相关肾病和免疫复合物肾病都被认为是艾滋病毒感染的并发症。尽管 20 世纪 90 年代末有效的抗逆转录病毒疗法的引入极大地改善了感染者的生存和健康状况，但几种常用的抗逆转录病毒药物与肾损伤有关。HIV 感染和治疗还可能促进糖尿病等传统危险因素导致的慢性肾病的进展，而 HIV 是高危 APOL1 基因型的最强“二次打击”之一。感染者慢性肾病管理中的独特考虑因素很大程度上与终生抗逆转录病毒治疗的需要有关，并且可能存在毒性、药物间相互作用和多重用药。患有进行性慢性肾病的 PWH 是所有肾脏替代疗法（包括肾移植）的候选者，在一些中心，PWH 可能是艾滋病毒受体捐赠者的候选者。来自艾滋病毒捐献者的同种异体肾脏移植也为研究肾脏中的病毒动力学提供了独特的机会，这对肾脏健康和艾滋病毒治疗研究具有重要意义。此外，HIV转基因动物模型为了解HIV以外的肾脏疾病发病机制提供了重要见解，并且HIV和HIV相关肾脏疾病的经验为未来的流行病提供了重要的教训。