title: HIV-associated nephropathy in the setting of maximal virologic suppression.
abstract: Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is most frequently seen as a late manifestation in adult patients with a high viral load and low T-helper cell (CD4) counts. We report a case of HIVAN in a black Zimbabwean teenager in whom the disease activity was well suppressed for years following highly active antiretroviral therapy (HAART). Proteinuria was absent at 9 years of age when he presented with vertically transmitted HIV infection. Within a few months of HAART, the viral load became undetectable and CD4 count was normalised. Nephrotic range proteinuria, with preserved renal function, developed approximately 4 years later despite excellent HIV disease suppression. Renal biopsy showed non-collapsing focal segmental glomerular sclerosis changes compatible with HIVAN. Although the role of other unknown factors in the disease pathogenesis could not be totally excluded, this case demonstrates that HIVAN can still occur in HIV-infected children despite excellent HAART and that the disease manifestations and outcome may differ from those reported in previous studies.
authors.affiliation: Department of Paediatric Nephrology, University Hospital of Wales, Cardiff, CF14 4XW, UK. Shivaram.Hegde@wales.nhs.uk
authors.forename: Shivaram
authors.initials: S
authors.lastname: Hegde
authors.forename: Cheentan
authors.initials: C
authors.lastname: Singh
authors.forename: Bernadette
authors.initials: B
authors.lastname: Ohare
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D005923:Glomerulosclerosis, Focal Segmental / Q000209:etiology / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology*; D008297:Male; D012074:Remission Induction; D019562:Viral Load