Infection with hepatitis B virus (HBV) may be associated with a variety of renal diseases. In the past, HBV was the major cause of viral hepatitis in patients with end-stage renal disease (ESRD). Introduction of rigorous infection-control strategies has led to a remarkable decline in the spread of HBV infection in dialysis units. Physicians also are increasingly recognizing the association between chronic hepatitis C virus (HCV) infection and glomerular disease, both in native kidneys and renal allografts. Liver disease caused by HCV is a major factor in morbidity and mortality among patients with ESRD treated with dialysis and transplantation. The first part of this chapter focuses mainly on issues related to HCV infection. The second part of this chapter examines the renal complications in patients with human immunodeficiency virus (HIV) infection.
Our knowledge about HIV has increased greatly, and dramatic advances have occurred in the treatment of patients with acquired immunodeficiency syndrome (AIDS). For the first time since the discovery of the disease, deaths are decreasing. Nevertheless, in the United States, as of June 30, 1997, there were over 600,000 cumulative cases of HIV infection, with over 400,000 deaths. Worldwide, the HIV epidemic continues to spread; an estimated 20 million persons are infected with HIV. Recent advances in the clinical management of these patients result from better understanding of the replication kinetics of HIV, assays to measure viral load, availability of new effective drugs against HIV, and demonstration that aggressive protocols combining antiviral drugs substantially reduce HIV replication. Thus, prolonged survival of patients
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