title: Hiv-associated nephropathy occurring before HIV antibody seroconversion.
abstract: It currently is thought that human immunodeficiency virus-associated nephropathy (HIVAN) occurs late in the course of HIV infection. Although HIVAN may be the presenting manifestation of acquired immunodeficiency syndrome (AIDS), it usually occurs after a prolonged period of viral infection often associated with high levels of HIV viremia. The patient described here developed HIVAN as a manifestation of acute retroviral syndrome. A 41-year-old black man presented with nephrotic range proteinuria, renal insufficiency, and acute gastrointestinal and pulmonary symptoms. He recently had been treated for primary syphilis. Two HIV serologic tests, performed 3 months apart, were negative. Renal biopsy was consistent with HIVAN. After the biopsy, the patient was discovered to have more than 700,000 viral copies per mL in his blood. CD4(+) count was greater than 500/mm(3). Six weeks later, enzyme-linked immunosorbent assay and Western blot analyses for HIV antibody became positive. HIVAN can occur early in the course of HIV infection, even during acute infection before seroconversion, and prolonged exposure to virus is not necessary for this renal involvement to occur in the susceptible host.
authors.affiliation: Divisions of Nephrology, Infectious Disease, and General Internal Medicine, Department of Medicine, and Department of Pathology, Northwestern University Medical School, Chicago, IL 60611, USA. m-levin@northwestern.edu
authors.forename: M L
authors.initials: ML
authors.lastname: Levin
authors.forename: F
authors.initials: F
authors.lastname: Palella
authors.forename: S
authors.initials: S
authors.lastname: Shah
authors.forename: E
authors.initials: E
authors.lastname: Lerma
authors.forename: J
authors.initials: J
authors.lastname: Butter
authors.forename: Y S
authors.initials: YS
authors.lastname: Kanwar
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000473:pathology*; D000328:Adult; D001706:Biopsy; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000821:virology; D008297:Male; D051437:Renal Insufficiency / Q000473:pathology / Q000821:virology; D014766:Viremia / Q000150:complications