title: 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).
  
  
  CONCLUSIONS
  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: Department of Nephrology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
authors: Naïke
authors: N
authors: Bigé
authors: Fanny
authors: F
authors: Lanternier
authors: Jean-Paul
authors: JP
authors: Viard
authors: Prochore
authors: P
authors: Kamgang
authors: Eric
authors: E
authors: Daugas
authors: Caroline
authors: C
authors: Elie
authors: Kaoutar
authors: K
authors: Jidar
authors: Francine
authors: F
authors: Walker-Combrouze
authors: Marie-Noelle
authors: MN
authors: Peraldi
authors: Corinne
authors: C
authors: Isnard-Bagnis
authors: Aude
authors: A
authors: Servais
authors: Olivier
authors: O
authors: Lortholary
authors: Laure-Hélène
authors: LH
authors: Noël
authors: Guillaume
authors: G
authors: Bollée
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D015497:HIV-1; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012084:Renin-Angiotensin System; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult