Proliferative glomerulonephritis in lupus patients with human immunodeficiency virus infection: a difficult clinical challenge.
OBJECTIVE
To describe the unusual occurrence of systemic lupus erythematosus (SLE) with nephritis in human immunodeficiency virus (HIV)-infected individuals.


METHODS
Chart review-based report of a case of SLE with diffuse proliferative glomerulonephritis (DPGN) in an HIV-infected man, together with a literature review of previously published cases. We searched the English language medical literature from 1987 to 2009 using the following PubMed and Medline terms: "SLE," "HIV," "DPGN." In addition, we researched the role of mycophenolate mofetil (MMF) in the treatment of patients with HIV by using the keywords "MMF" and "HIV".


RESULTS
An 18-year-old male patient with vertically transmitted HIV-1 infection presented with malaise, weight loss, malar rash, arthritis, proteinuria, and hematuria. Kidney biopsy confirmed the diagnosis of lupus nephritis (Class IV). He was treated successfully with high-dose corticosteroids and MMF, which were added to his baseline treatment of highly active antiretroviral therapy. The review of the literature identified a total of 18 cases of SLE appearing in HIV+ individuals, of which 11 patients had lupus nephritis. Among the latter, there were only 5 cases of proliferative (focal or diffuse) glomerulonephritis, and their treatment consisted mainly of high-dose corticosteroids. The short-term outcome was favorable in 4 cases and 1 patient died.


CONCLUSIONS
Proliferative lupus nephritis is rare in HIV-infected patients. A detailed analysis of the cases may lead to important insights into the pathogenic mechanisms of both diseases. Considering its complex interaction with antiviral medications, MMF may be considered for the treatment of lupus with severe proliferative glomerulonephritis in HIV-infected individuals.
Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA. chaim.putterman@einstein.yu.edu
Simona
S
Gindea
Julie
J
Schwartzman
Leal C
LC
Herlitz
Michael
M
Rosenberg
Jacobo
J
Abadi
Chaim
C
Putterman
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001706:Biopsy; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D044966:Anti-Retroviral Agents; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid