Human immunodeficiency virus associated nephropathy (Hivan) is a distinct renal disease described in patients infected with the human immunodeficiency virus (HIV). Hivan is characterized by a
nephrotic syndrome, enlarged kidneys, a histologic finding of focal and
segmental glomerulosclerosis, and a very rapid progression to
end-stage renal disease (
ESRD). No therapeutic intervention has been shown, in a prospective evaluation, to either alter the course of established Hivan or to influence the emergence of Hivan in HIV-infected patients. We conducted a prospective study on 23 consecutively selected patients seen between 1989 and 1992 who were infected with the HIV, 14 (61%) of whom had significant
proteinuria (> or = 2+). Percutaneous kidney biopsy was performed in 5 (36%) of the 14 subjects who had significant
proteinuria, and histologic examination of the kidney tissue revealed focal and
segmental glomerulosclerosis in all 5 cases. Of the 14 subjects with
proteinuria, 8 (57%) also had
azotemia (serum
creatinine level > or = 1.3 mg/dl). Nine (39%) of 23 subjects admitted intravenous
drug use, while 9 (39%) of 23 subjects have had an
opportunistic infection before enrollment in the study. The known duration of
HIV infection before initiation of
zidovudine therapy was 10.3 +/- (SD) 8 months. The mean CD4 count before
zidovudine therapy was 195.9 +/- 117 (range 21-654) cells/mm3. The mean dose of
zidovudine administered was 543 +/- 117 (range 400-800) mg daily for a period of 20.4 +/- 11 (range 6-38) months.(ABSTRACT TRUNCATED AT 250 WORDS)