Figure 736

Effect of angiotensin-converting enzyme (ACE) inhibitors on progression of glomerulosclerosis associated with HIV infection. Serum ACE levels are increased in patients with HIV infection [184]. Kimmel and colleagues [180], using captopril, and Burns and colleagues [185], using fosinopril, demonstrated a renoprotective effect of ACE inhibitors in patients with biopsy-proven HIV-associated glomeru-losclerosis. In the former study, the median time to end-stage renal disease was increased from 30 to 74 days in nine patients given 6.25 to 25 mg captopril three times a day. In the latter study, 10 mg of fosinopril was given once a day to 11 patients with early renal insufficiency (serum creatinine <2 mg/dL). Serum creatinine and proteinuria remained stable during 6 months of treatment with fosinopril. In contrast, patients not treated with fosinopril exhibited progressive and rapid increases in serum creatinine and proteinuria. Similar outcomes prevailed in patients with proteinuria in the nephrotic range and serum creatinine levels less than 2 mg/dL. Captopril also is beneficial to the progression of the nephropathy in HIV-transgenic mice [186]. The mechanism(s) of the renoprotective effects of ACE inhibitors are unclear and may include hemodynamic effects, decreased expression of growth factors, or an effect on HIV protease activity. Renal biopsy early in the course of the disease is important to define the renal lesion and guide therapeutic intervention.

Reference

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Patients

Mean survival,

Rao et ai [187]

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