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HIVAN Management — ESENeph MCQ

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ModerateGlomerulonephritisHIVAN ManagementESENeph

A 45-year-old man with HIV-associated nephropathy (HIVAN) has started antiretroviral therapy. His viral load is now undetectable and CD4 is 380 cells/mm3. His eGFR is 35 mL/min/1.73m2 with proteinuria 3.5 g/day. What additional renoprotective measure is recommended?

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Correct answer: B — ACE inhibitor or ARB

In HIVAN, ART is the primary treatment and dramatically improves outcomes. Additionally, ACEi/ARB therapy is recommended for proteinuria reduction and renoprotection (extrapolated from CKD evidence). KDIGO 2021 GN guideline acknowledges the role of RAS blockade in HIVAN. Immunosuppression is not routinely recommended. SGLT2i may also be considered in the context of CKD with proteinuria, though specific trial data in HIVAN is limited.

Reference: https://guidelines.ukkidney.org