The spectrum of renal histologies seen in HIV with outcomes, prognostic indicators and clinical correlations.
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.
Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. Nicola.Dave@uct.ac.za
Nicola
N
Wearne
Charles R
CR
Swanepoel
Andrew
A
Boulle
Maureen S
MS
Duffield
Brian L
BL
Rayner
D016263:AIDS-Associated Nephropathy / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D011379:Prognosis; D016019:Survival Analysis
D044966:Anti-Retroviral Agents