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Urologic complications of HIV and AIDS

Nature Clinical Practice Urology volume 6, pages 32–43 (2009)Cite this article

A Correction to this article was published on 01 April 2010

Abstract

In recent years the nature of HIV infection has been dramatically transformed from an invariably fatal disease to a chronic disorder with a relatively benign course. Disease progression from HIV to AIDS and HIV-related mortality can be reduced effectively by several years of treatment with highly active antiretroviral therapy (HAART). For patients who do not have access to HAART, HIV infection continues to be a lethal disorder characterized by opportunistic infection with uncommon organisms (e.g. mycobacteria, fungi, parasites and viruses), as well as lethal malignancies such as Kaposi sarcoma, non-Hodgkin lymphoma and squamous cell carcinoma of the penis or cervix. In patients receiving HAART, urologic complications are likely to be caused by adverse effects of antiretroviral medication (e.g. indinavir urolithiasis) or disorders associated with aging, such as benign prostatic hyperplasia and prostate cancer. Prospective clinical trials have shown that adult male circumcision can reduce the rate of female to male HIV transmission by more than 50%; however, the development of preventive or curative modalities with 100% efficacy remains elusive.

Key Points

  • Several regions worldwide still do not have access to highly active antiretroviral therapy (HAART); patients with HIV who do not receive HAART are at a high risk of developing opportunistic infections, which usually originate in urologic organs

  • Urologic complications are often the first clinical signs of HIV and AIDS

  • In patients with HIV and AIDS, urologic complications are typically the result of infection by mycobacteria, parasites, fungi and viruses

  • Urologic complications of HIV and AIDS include renal dysfunction, urinary tract infection, bladder dysfunction, urogenital tuberculosis, prostatitis, prostatic abscess, epididymo-orchitis, Fournier gangrene, urologic malignancies, sexual dysfunction and infertility

  • There is some evidence that adverse effects of HAART cause urologic complications such as urolithiasis and renal dysfunction

  • Prospective clinical trials have shown that adult male circumcision reduces the risk of female to male HIV transmission by more than 50%; however, further research is still needed

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Figure 1: Tuberculous pyonephrosis with widespread caseous necrosis of the renal parenchyma in an HIV-positive patient with a low CD4+ cell count.
Figure 2: Kaposi sarcoma causing lymphedema of the penis, scrotum and right leg due to inguino-pelvic lymph-node metastases in an HIV-positive man.
Figure 3: Extensive squamous cell carcinoma of the penis involving the scrotum and inguinal lymph nodes in an HIV-positive patient with a low CD4+ cell count.
Figure 4: Excretory urogram (intravenous pyelogram) shows filling defects in the renal collecting system due to urolithiasis in a patient with AIDS receiving treatment with indinavir.

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Authors and Affiliations

  1. Stellenbosch; Head of the Department of Urology at Tygerberg Hospital, CF Heyns is Professor of Urology at the University of Stellenbosch, Cape Town, South Africa; and President of the College of Urologists of South Africa.,

    Chris F Heyns

  2. Head of the Department of Urology at Tygerberg Hospital, Cape Town, South Africa,

    Chris F Heyns

  3. AE Groeneveld is a Urologist in Mbabane, Swaziland.,

    Adam E Groeneveld

  4. NB Sigarroa is Professor in Urology at the Walter Sisulu University (formerly the University of the Transkei), Mthatha, Eastern Cape, South Africa.,

    Nelson B Sigarroa

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  1. Chris F Heyns
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Correspondence to Chris F Heyns.

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Heyns, C., Groeneveld, A. & Sigarroa, N. Urologic complications of HIV and AIDS. Nat Rev Urol 6, 32–43 (2009). https://doi.org/10.1038/ncpuro1273

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