HIV and the kidney

Written by: Professor Jeremy Levy
Published: | Updated: 11/12/2018
Edited by: Cal Murphy

HIV. One of the most well-known and often feared diseases in the world, this infection has been part of the public consciousness since the 1980s. While awareness of the disease itself is very high, many people are not aware of its effect on other parts of the body. Expert nephrologist Professor Jeremy Levy explains the effect HIV can have on the kidney:

HIV causing kidney problems

People with HIV can have kidney problems from a variety of causes, and this is very common. HIV itself can infect the kidneys (HIV-associated nephropathy, or HIVAN most commonly) and cause problems including poor kidney function, acute kidney injury, chronic kidney disease, proteinuria (protein in the urine), high blood pressure, and it can even cause kidney failure.

The drugs used to treat HIV (anti-retroviral drugs) can be damaging to the kidneys, including medications such as tenofovir (TDF), atazanavir, protease inhibitors and more. Other medications needed by patients, such as antibiotics or anti-viral agents can be toxic to kidneys. Many people living with HIV get high blood pressure, diabetes, or vascular disease (especially if they smoke) and these can all lead to kidney damage, especially as people living with HIV are getting older.


Nephropathy – what to look out for

Very often, nephropathy caused by HIV does not cause any symptoms, but can be detected by urine and blood tests. If the kidneys are damaged they almost always leak blood or protein into the urine, which is detected by a urine test, and is often the first or only sign. This is usually not visible. When symptoms do rarely occur they can be similar to symptoms of other kidney conditons like glomerulonephritis, including swelling of the legs (oedema), sometimes shortness of breath, abdominal pain, or fatigue, nausea and vomiting if severe.

Diagnosing HIV-associated nephropathy or kidney damage

To make a diagnosis, it is necessary to perform blood and urine tests, an ultrasound scan, and sometimes a kidney biopsy (a small sample is taken out from one kidney through a needle, under local anaesthetic).


Treating the kidney damage

Treatment will depend on the precise cause of the kidney damage. Often, this includes changes to the anti-retroviral drugs in close collaboration with the HIV doctors, and the patient may need new medications for blood pressure or diabetes, and sometimes other drugs to treat inflammation in the kidneys. All this requires close monitoring.

Patients are also advised to stop smoking, eat a healthy, balanced diet, and exercise. For most patients the kidney damage will only be mild, but it can sometimes (rarely) lead to complete kidney failure and the need for dialysis or a kidney transplant. Kidney transplantation can be performed if needed in patients with HIV and kidney failure and can be extremely successful.


If you are experiencing symptoms of kidney damage, whether you have HIV or not, you should consult your doctor, or a specialist.

By Professor Jeremy Levy

Professor Jeremy Levy is a highly distinguished consultant nephrologist based in London who specialises in the treatment and management of all aspects of kidney diseases, including chronic kidney disease, glomerulonephritis, diabetic kidney disease (nephropathy), HIV and kidney disease, polycystic kidney disease (APKD), proteinuria and nephrotic syndrome. In addition to hypertension, he is also an expert in immune-mediated renal diseases, such as vasculitis and systemic lupus erythematosus (SLE). Professor Levy currently sees patients at Charing Cross Hospital, Imperial Private Healthcare.

Professor Levy qualified from the University of Cambridge in 1989 and completed his nephrology training in London and Oxford. He then obtained a PhD in renal immunology from Imperial College London in 1999 and later became a fellow of the Royal College of Physicians of London in 2004. Following this, Professor Levy was appointed consultant nephrologist and physician at Charing Cross and Hammersmith Hospitals (Imperial College Healthcare) and at Chelsea and Westminster Hospital, where he leads the renal service.

Besides his nephrology practice, Professor Levy is actively involved in research and medical education, invited to teach worldwide, including for the International Society of Nephrology and European Renal Association. He is the author of textbooks on dialysis and nephrology, including the Oxford Handbook of Dialysis, and is professor of practice (Medicine) at Imperial College, London, where he additionally serves as director of clinical academic training. Previously, Professor Levy chaired the UK Renal Association Education and Training Committee. Additionally, Professor Levy is the regional speciality advisor for renal medicine for the Royal College of Physicians and supports academic training nationally for the National Institute for Health Research (NIHR).

View Profile

Overall assessment of their patients

  • Related procedures
  • Kidney transplantation
    Hypertension (high blood pressure)
    Vascular disease
    Smoking cessation (quitting)
    Acute kidney failure
    Diabetic nephropathy
    Nephritic syndrome
    Nephrotic syndrome
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.