Presentation of HIV-associated nephropathy and outcome in HAART-treated patients.

Abstract

BACKGROUND:

Among the numerous renal diseases observed in human immunodeficiency virus (HIV) patients, HIV-associated nephropathy (HIVAN) is a major cause of end-stage renal disease (ESRD). The purpose of our study was to describe the presentation and outcome of HIVAN in the era of highly active antiretroviral therapy (HAART).

METHODS:

We analysed clinical features and outcome of 57 patients with histologically proven HIVAN diagnosed between 2000 and 2009 in four teaching hospitals in Paris, France.

RESULTS:

This series was characterized by median age of 41 years (18-58), frequent African origin (87%), severe renal dysfunction [estimated glomerular filtration rate (eGFR) 20 mL/min/1.73m(2) (1-68)], high-grade proteinuria [4.1 g/day (0.6-16.8)], high proportion of sclerotic glomeruli [31.5% (0-95)], high HIV load [4.5 log copies/mL (0-6.7)] and low CD4+ count [127/mm(3) (3-713)]. Nevertheless, a non-negligible proportion of patients did not present with these typical features. Follow-up data were available for 51 patients. ESRD occurred in 30 patients (58.8%). Median renal survival was 40 months. Baseline characteristics significantly associated with ESRD were as follows: severity of renal dysfunction, percentage of sclerotic glomeruli, time from HIV infection to HIVAN diagnosis longer than 1 year and prior exposure to antiretroviral drugs. There was an insignificant trend towards better renal outcome being associated with viral suppression during follow-up. Use of renin-angiotensin system (RAS) blockers was associated with higher renal survival (P < 0.05).

CONCLUSION:

Despite HAART, HIVAN led to ESRD in more than half of the cases. Early recognition of the disease is crucial to start HAART and RAS blockers before irreversible renal injury.

• Authors: Naïke Bigé, Fanny Lanternier, Jean-Paul Viard, Prochore Kamgang, Eric Daugas, Caroline Elie, Kaoutar Jidar, Francine Walker-Combrouze, Marie-Noelle Peraldi, Corinne Isnard-Bagnis, Aude Servais, Olivier Lortholary, Laure-Hélène Noël, Guillaume Bollée
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 27 Issue 3 Pg. 1114-21 (Mar 2012) ISSN: 1460-2385 [Electronic] England
• PMID: 21745806 (Publication Type: Journal Article, Multicenter Study)

Topics

• AIDS-Associated Nephropathy (diagnosis, etiology)
• Adolescent
• Adult
• Antiretroviral Therapy, Highly Active (adverse effects)
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• HIV Infections (complications, drug therapy, pathology)
• HIV-1
• Humans
• Kidney Failure, Chronic (etiology, mortality, pathology)
• Male
• Middle Aged
• Prognosis
• Renin-Angiotensin System
• Retrospective Studies
• Survival Rate
• Young Adult