ARE ARBS THE PREFERRED AGENTS TO TREAT HYPERTENSION IN PATIENTS WITH HIVNEPHROPATHY WITH ALBUMINURIA

Numerous signs of renal dysfunction such as proteinuria, crystalluria and microhematuria as well as a variety of other renal syndromes may characterize the course of HIV infection and lead to renal failure. It is estimated that approximately 1% to 2% of patients starting dialysis suffer from HIV-associated renal disease. HIV-associated nephropathy (HIVAN) occurs in about 10% of HIV-infected subjects with a distinct predilection for Blacks and Hispanic individuals. This nephropathy is characterized by glomerular basement membrane thickening, wrinkling and folding, segmental or global collapse of the glomerular tufts, increase in the Bowman space, and podocytes abnormalities. Large podocytes filled with protein droplets often accumulate in layers around the collapsed areas forming the pseudocrescents. Tubular atrophy, interstitial inflammation and different degree of fibrosis are generally associated with the glomerular damage. Until antiretroviral therapy (ART) became available, HIVAN was characterized by a rapid renal function decline and progression to end-stage renal disease. Aside from the HIV direct injury to the nephron, numerous experimental observations lend support to the notion that Angiotensin II contributes to podocytes damage and treatment with angiotensin-converting enzyme inhibitors (ACE-Is) as well as angiotensin receptor