HIV ‐associated nephropathy: A decade of clinical outcomes, global disparities and emerging promise

OBJECTIVE: To review the pathogenesis, epidemiology, clinical presentation, management and outcomes of HIV-associated nephropathy (HIVAN), with emphasis on global disparities, genetic susceptibility (APOL1) and emerging therapeutic and technological advances. DESIGN: Narrative literature review synthesizing contemporary evidence from clinical cohorts, translational research and guideline-based practice, with comparative perspectives from high-resource (UK) and low-resource (sub-Saharan Africa) settings. METHODS: Relevant studies were analysed to evaluate mechanisms of disease, epidemiological trends, diagnostic approaches, treatment strategies and long-term outcomes. Particular focus was placed on APOL1-associated risk, antiretroviral therapy (ART) impact and recent developments including artificial intelligence (AI) applications and targeted therapies. RESULTS: HIVAN arises from direct HIV infection of renal epithelial cells in genetically susceptible individuals, particularly those with APOL1 risk variants. ART has significantly reduced incidence in high-income settings, whereas HIVAN remains prevalent in sub-Saharan Africa due to delayed diagnosis and limited healthcare access. Clinically, HIVAN presents with proteinuria and progressive kidney dysfunction, requiring biopsy for confirmation. Early ART initiation improves renal outcomes, supported by adjunctive therapies such as renin-angiotensin system blockade and SGLT2 inhibitors. Emerging therapies targeting APOL1 and advances in AI-driven risk prediction and diagnostics show promise. CONCLUSIONS: HIVAN reflects an interplay between viral, genetic and socio-economic factors. While ART has transformed outcomes in well-resourced settings, significant global disparities persist. Future progress depends on improving HIV care access, expanding renal services and advancing precision medicine approaches, including APOL1-targeted therapies and AI-enabled risk stratification.