title: The changing pattern of glomerular disease in HIV and hepatitis C co-infected patients in the era of HAART.
abstract: Previous reports have suggested a poor renal prognosis in patients with HIV and HCV co-infection with a preponderance of immune complex mediated glomerular disease on biopsy. Although the benefits of HAART on HIVAN are known, its impact on co-infected patients is unclear. We describe the renal biopsy findings and renal outcome in 29 co-infected patients in the HAART era and compare them to findings in 14 historical controls reported from our institution in the pre-HAART era. Our present cohort was predominantly male and Black with the majority reporting a history of intravenous (i.v.) drug use. Renal biopsy findings included 16 patients with immune complex mediated glomerular disease and 14 patients with FSGS, of which only 3 had collapsing features and/or tubular microcysts typical of HIVAN. Five patients had other biopsy diagnoses not directly related to viral infection. Median renal survival in our cohort was 15.6 months - significantly better than the 1.7 months seen our pre-HAART cohort. The modern cohort's improved renal outcome occurred despite older patients, longer HIV infection and similar levels of renal insufficiency. Our data indicate a changing epidemiology and natural history of renal disease in the HAART era with less immune complex mediated glomerular disease and more non-collapsing FSGS of the usual type. The marked improvement is likely to be multifactorial, including use of antiretroviral and anti-HCV therapies, RAAS antagonists, earlier nephrology referral and generally improved medical care.
authors: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. sm2206@columbia.edu
authors: Sumit
authors: S
authors: Mohan
authors: Leal C
authors: LC
authors: Herlitz
authors: Jennifer
authors: J
authors: Tan
authors: Jen-Tse
authors: JT
authors: Cheng
authors: Herman L
authors: HL
authors: Anderson
authors: Michael B
authors: MB
authors: Stokes
authors: Glen S
authors: GS
authors: Markowitz
authors: Vivette D
authors: VD
authors: D'Agati
authors: Jai
authors: J
authors: Radhakrishnan
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology / Q000401:mortality / Q000473:pathology; D000328:Adult; D001741:Black or African American; D000936:Antigen-Antibody Complex / Q000032:analysis; D023241:Antiretroviral Therapy, Highly Active; D015142:Baltimore / Q000453:epidemiology; D001706:Biopsy; D060085:Coinfection; D005921:Glomerulonephritis / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology / Q000401:mortality / Q000473:pathology; D015432:Glomerulonephritis, Membranoproliferative / Q000453:epidemiology / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology / Q000473:pathology; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007678:Kidney Glomerulus / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010297:Paris / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000208:ethnology; D013997:Time Factors
chemical_list: D000936:Antigen-Antibody Complex