title: HIV-associated kidney glomerular diseases: changes with time and HAART.
abstract: BACKGROUND
  Treatment and co-morbidities of human immunodeficiency virus (HIV)-infected individuals have changed dramatically in the last 20 years with a potential impact on renal complications. Our objective was to assess the change in distribution of the glomerular diseases in HIV patients.
  
  
  METHODS
  We retrospectively analysed demographic, clinical, laboratory and renal histopathological data of 88 HIV-infected patients presenting with a biopsy-proven glomerular disease between 1995 and 2007.
  
  
  RESULTS
  In our study including 66% Black patients, HIV-associated nephropathy (HIVAN) was observed in 26 cases, classic focal segmental glomerulosclerosis (FSGS) in 23 cases, immune complex glomerulonephritis in 20 cases and other glomerulopathies in 19 patients. HIVAN decreased over time, while FSGS emerged as the most common cause of glomerular diseases (46.9%) in HIV-infected individuals undergoing kidney biopsy in the last 2004-07 period. Patients with HIVAN were usually Black (97%), with CD4 <200/mL (P = 0.01) and glomerular filtration rate <30 mL/min/1.73 m(2) (P < 0.01). Compared to HIVAN, patients with classic FSGS were less often Black (P < 0.01), have been infected for longer (P = 0.03), were more often co-infected with hepatitis C virus (P = 0.05), showed more often cardiovascular (CV) risk factors (P < 0.01), had less often CD4 <200/mL (P = 0.01), lower HIV viral load (P = 0.01) and tended to be older (P = 0.06).
  
  
  CONCLUSIONS
  Classic FSGS associated with metabolic and CV risk factors has overcome HIVAN in HIV-infected patients. Compared with other glomerulopathies, HIVAN remains strongly associated with severe renal failure, Black origin and CD4 lower than 200/mL at presentation.
authors.affiliation: Department of Infectious and Tropical Diseases, Tenon Hospital, AP-HP, Paris, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Lescure
authors.forename: Clara
authors.initials: C
authors.lastname: Flateau
authors.forename: Jérôme
authors.initials: J
authors.lastname: Pacanowski
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brocheriou
authors.forename: Eric
authors.initials: E
authors.lastname: Rondeau
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.forename: Pierre
authors.initials: P
authors.lastname: Ronco
authors.forename: Gilles
authors.initials: G
authors.lastname: Pialoux
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Plaisier
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000209:etiology* / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005923:Glomerulosclerosis, Focal Segmental / Q000209:etiology* / Q000401:mortality; D006678:HIV / Q000302:isolation & purification / Q000472:pathogenicity*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors