The renal system
Kidney disease has been recognized as a complication of HIV and AIDS since the early 1980s (1). Renal function is known to diminish with age (2,3). Thus, both acute and chronic kidney disease are likely to present an increasing burden on the aging population of antiretroviral-treated patients. Projected increases in the prevalence of end-stage renal disease attributed to HIV (4) are compounded by racial disparities in new HIV/AIDS diagnoses among older adults, as minority patients at increased risk for kidney disease make up a growing proportion of the aging HIV population. Even in the absence of kidney disease or systemic illness, kidney function declines slowly with age (5). Recognition of this physiologic, age-related decline in kidney function is essential to guide medication dosing and identify patients at increased risk of acute renal failure, medication toxicity, and chronic kidney disease.
