37 Renal Complications The pathogenesis of renal disease in HIV-positive individuals is diverse. It includes: 1) HIV-associated nephropathy (HIVAN), a form of focal segmental glomerulosclerosis that is accompanied by tubuleinterstitial inflammation, and clinically manifests as rapidly progressive renal failure with nephritic range proteinuria. 2) HIV immune complex kidney Inhibitors,research,lifescience,medical disease (HIVICK), a collective term that includes

IgA nephropathy, membranoproliferative glomerulonephritis, membranous nephropathy, and a lupus-like glomerulonephritis that is serologically negative.38 3) Hypertensive and atherosclerotic renal disease. 4) ART side-effects, mainly tenofovir-induced renal tubular injury39 and indinavir/atazanavir-induced crystaluria and renal calculi formation.40 The first two pathologies are more common in untreated patients, the last two in treated. It has been shown that chronic kidney disease and Inhibitors,research,lifescience,medical proteinuria are associated with increased risk of mortality in HIV-positive patients.41 Bone Mineral Density and Osteoporosis Several

population-based studies in the United States showed increased prevalence of osteoporotic fractures in HIV-infected men and women compared with HIV-uninfected individuals.42 The etiology of low bone mineral density (BMD) in HIV-positive patients is multifactorial. It Inhibitors,research,lifescience,medical includes both traditional, non-HIV-related risk factors such as smoking, alcohol and opiate use, low body weight, and vitamin D deficiency; and also HIV-related factors such as direct viral and inflammatory effects on bone resorption43,44 and the effects of ART, especially tenofovir.45 Multiple studies have shown a 2%–6% BMD loss after 48–96 weeks of therapy, regardless of the

Inhibitors,research,lifescience,medical type of ART initiated.46 Several longitudinal studies have shown that, with continued ART use, BMD stabilizes over time.47,48 Neurocognitive Changes HIV-associated neurocognitive disorder (HAND) is divided into three levels of impairment: asymptomatic neurocognitive impairment, mild neurocognitive disorders, and HIV-associated dementia (HAD). The introduction of ART has reduced significantly the rate of HAD, but unfortunately Inhibitors,research,lifescience,medical the effect on less severe forms of impairment is not as impressive. Studies of HAND in treated patients have documented high persisting rates of mild-to-moderate neurocognitive impairment despite effective suppressing Ketanserin antiretroviral treatment,49 especially in individuals with a history of low nadir CD4s.50 Frailty Syndrome in HIV-positive Older Adults Frailty is defined as a syndrome of decreased physiological reserve, which increases vulnerability to negative outcomes such as loss of independence, this website nursing home admission, morbidity, and mortality.51 Recent studies demonstrated that HIV-positive individuals are at an increased risk of frailty and that some individuals with HIV manifest frailty characteristics at a much younger age than frail individuals without HIV.