Effect of angiotensin-converting enzyme inhibition in HIV-associated nephropathy

• Published in: Journal of the American Society of Nephrology Vol. 8; no. 7; pp. 1140 - 1146
• Main Authors: BURNS, G. C, PAUL, S. K, TOTH, I. R, SIVAK, S. L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.07.1997
• Subjects: AIDS-Associated Nephropathy - drug therapy; AIDS-Associated Nephropathy - metabolism; AIDS-Associated Nephropathy - pathology; AIDS/HIV; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive agents; Biological and medical sciences; Cardiovascular system; Creatinine - blood; Female; Fosinopril - therapeutic use; Glomerulonephritis; HIV-1; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Nephrotic Syndrome - drug therapy; Nephrotic Syndrome - metabolism; Nephrotic Syndrome - pathology; Pharmacology. Drug treatments; Proteinuria - drug therapy; Time Factors; Kidney disease; Creatinine; Human; Immunopathology; Urinary system disease; Renal function; Treatment efficiency; AIDS; Immune deficiency; Infection; Concomitant disease; Nephropathy; Viral disease; Fosinopril; ACE inhibitor
• DOI: 10.1681/ASN.V871140
• ISSN: 1046-6673

Angiotensin-converting enzyme inhibition (ACEI) delays progression of diabetic and nondiabetic renal disease. This study examined the effect of fosinopril, 10 mg by mouth daily, in HIV-associated nephropathy (HIV-AN). Twenty patients with HIV-AN were studied. Of 11 patients with non-nephrotic-range proteinuria, 7 received treatment and 4 did not. Average baseline creatinine (mg/dl) for treated and nontreated patients was 1.3 +/- 0.24 and 1.0 +/- 0.25, respectively (P = 0.07). At 24 wk, creatinine of treated and nontreated patients was 1.5 +/- 0.34 and 4.9 +/- 2.4 (P = 0.006). Average baseline 24-h urine protein excretion (g/d) for treated and nontreated patients was 1.6 +/- 0.68 and 0.78 +/- 0.39, respectively (P = 0.02). At 24 wk, 24-h protein excretion of treated and non-treated patients was 1.25 +/- 0.86 and 8.5 +/- 1.4 (P = 0.006). Of nine patients with nephrotic-range proteinuria, five were treated and four were not. Average baseline creatinine for treated and nontreated patients was 1.7 +/- 0.46 and 1.9 +/- 0.42, respectively (P = 0.4). At 12 wk, creatinine for treated and nontreated patients was 2.0 +/- 1.0 and 9.2 +/- 2.0 (P = 0.02). The baseline 24-h protein excretion for treated and nontreated patients was 5.4 +/- 1.6 and 5.2 +/- 0.97 (P = 0.9). At 12 wk, 24-h protein excretion for treated and nontreated was 2.8 +/- 1.0 and 10.5 +/- 3.5 (P = 0.008). These preliminary data suggest that treatment with ACEI may stabilize serum creatinine and 24-h protein excretion for up to 24 wk in patients with non-nephrotic-range proteinuria and for up to 12 wk in patients with nephrotic-range proteinuria when initial serum creatinine is < or = 2.0 mg/dl. Furthermore, the renin-angiotensin system may play a role in HIV-AN, and early treatment with ACEI may be beneficial in HIV-AN.