Journal Article

The spectrum of renal histologies seen in HIV with outcomes, prognostic indicators and clinical correlations

Nicola Wearne, Charles R. Swanepoel, Andrew Boulle, Maureen S. Duffield and Brian L. Rayner

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 11, pages 4109-4118
Published in print November 2012 | ISSN: 0931-0509
Published online December 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr702
The spectrum of renal histologies seen in HIV with outcomes, prognostic indicators and clinical correlations

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Background

Two hundred and twenty-one HIV-positive renal biopsies were analysed from Groote Schuur Hospital to determine outcomes and prognostic indicators based on histology and clinical features.

Methods

The histology findings were compared with patient demographics, clinical and renal parameters, mortality, CD4 count and date of commencing combined anti-retroviral therapy (cART). Follow-up was between 1 and 3.5 years.

Results

We found a spectrum of renal histologies in HIV-positive patients of which HIV-associated nephropathy (HIVAN) was the most common histology. cART reduced the mortality in those with any feature of HIVAN by 57% [adjusted hazard ratio (AHR) 0.43, 95% confidence interval (CI) 0.22–0.85]. Of those patients with HIVAN who died, 79% died of renal failure as registered on their death certificate. Proteinuria and microcysts were shown to be poor prognostic indicators (AHR 1.36: 1.09–1.70 and 2.04: 1.24–3.37). In patients with HIVAN alone followed for up to 2 years on cART, estimated glomerular filtration rate remained stable and there was a trend towards decreased proteinuria. cART improved survival in patients with isolated immune complex disease.

Conclusions

As mortality is improved in patients with any feature of HIVAN or isolated immune complex disease, cART should be initiated once any of these histological features are established. We believe the spectrum of disease that constitutes HIVAN needs to be more specifically defined. The ultimate outcome may be determined by the histological subtype.

Keywords: HIVAN; outcomes; prognostic indicators; renal histology

Journal Article.  4039 words.  Illustrated.

Subjects: Nephrology

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