Sep. 18, 1998 In the first documented case of its kind, doctors at the University of Maryland Medical Center have been able to reverse kidney failure in an HIV-infected patient by putting the patient on highly active, triple-drug antiretroviral therapy. This case, published in the September 5, 1998, issue of The Lancet, provides the first evidence of a connection between highly active antiretroviral therapy and a dramatic improvement in kidney function in an AIDS patient who had started dialysis. It also suggests that the therapy may eliminate the need for long-term dialysis in HIV patients, although more study is needed.
"It has been the feeling among doctors who treat HIV patients that current antiretroviral therapy may help prevent kidney failure, but it had never been documented," said Emilio Ramos, M.D., a nephrologist at the University of Maryland Medical Center and associate professor at the University of Maryland School of Medicine. "Now we are beginning a study to look at patients with HIV and kidney disease to determine whether they could benefit from highly active antiretroviral therapy."
About 10 percent of patients with HIV infection develop kidney failure. Dr. Ramos says the antiretroviral therapy will not reverse kidney failure in patients who have been on dialysis for a long time and whose kidneys have deteriorated. He believes it is most effective in the early stages of kidney failure, as was the case with this particular patient.
The patient, a 37-year-old African-American male, was unaware of his HIV status when he first came to the medical center. A kidney biopsy revealed that his kidney failure was HIV-related. One week before going on dialysis, he was put on therapy of 20 mg of stavudine a day, 50 mg of larnivudine a day and 1,250 mg of nelfinavir twice daily.
Thirteen weeks later, the patient's kidneys regained normal function and hemodialysis was stopped. In addition, the patient's viral load decreased from more than 900,000 copies/ml to 500 copies/ml. A repeat kidney biopsy also revealed that inflammation on the kidney had almost completely disappeared.
"This case is encouraging, because it implies that even a late stage complication of HIV, such as kidney failure, can be reversed with these powerful drugs. It provides more hope for our patients," says Lori Fantry, M.D., an AIDS specialist at the University of Maryland Medical Center and assistant professor of medicine at the University of Maryland School of Medicine.
"Antiviral medications cost about $10,000 per year. They are very expensive but keeping a patient on dialysis for the rest of his life is also very costly," says Ravinder K. Wali, M.D., lead author of the article and fellow in the Division of Nephrology at the University of Maryland Medical Center. "This case showed that therapy may eliminate the need for long-term dialysis in some HIV patients." Dialysis costs more than $40,000 per year.
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