title: The kidney as a reservoir for HIV-1 after renal transplantation.
abstract: Since the recent publication of data showing favorable outcomes for patients with HIV-1 and ESRD, kidney transplantation has become a therapeutic option in this population. However, reports have documented unexplained reduced allograft survival in these patients. We hypothesized that the unrecognized infection of the transplanted kidney by HIV-1 can compromise long-term allograft function. Using electron microscopy and molecular biology, we examined protocol renal transplant biopsies from 19 recipients with HIV-1 who did not have detectable levels of plasma HIV-1 RNA at transplantation. We found that HIV-1 infected the kidney allograft in 68% of these patients. Notably, HIV-1 infection was detected in either podocytes predominately (38% of recipients) or tubular cells only (62% of recipients). Podocyte infection associated with podocyte apoptosis and loss of differentiation markers as well as a faster decline in allograft function compared with tubular cell infection. In allografts with tubular cell infection, epithelial cells of the proximal convoluted tubules frequently contained abnormal mitochondria, and both patients who developed features of subclinical acute cellular rejection had allografts with tubular cell infection. Finally, we provide a novel noninvasive test for determining HIV-1 infection of the kidney allograft by measuring HIV-1 DNA and RNA levels in patients' urine. In conclusion, HIV-1 can infect kidney allografts after transplantation despite undetectable viremia, and this infection might influence graft outcome.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale U845, Growth and Signaling Research Center, Paris Descartes University, Necker Hospital, Paris, France;
authors.forename: Guillaume
authors.initials: G
authors.lastname: Canaud
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dejucq-Rainsford
authors.forename: Véronique
authors.initials: V
authors.lastname: Avettand-Fenoël
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Viard
authors.forename: Dany
authors.initials: D
authors.lastname: Anglicheau
authors.forename: Frank
authors.initials: F
authors.lastname: Bienaimé
authors.forename: Mordi
authors.initials: M
authors.lastname: Muorah
authors.forename: Louise
authors.initials: L
authors.lastname: Galmiche
authors.forename: Olivier
authors.initials: O
authors.lastname: Gribouval
authors.forename: Laure-Helene
authors.initials: LH
authors.lastname: Noël
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Satie
authors.forename: Frank
authors.initials: F
authors.lastname: Martinez
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sberro-Soussan
authors.forename: Anne
authors.initials: A
authors.lastname: Scemla
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Gubler
authors.forename: Gérard
authors.initials: G
authors.lastname: Friedlander
authors.forename: Corinne
authors.initials: C
authors.lastname: Antignac
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Timsit
authors.forename: Andrea
authors.initials: A
authors.lastname: Onetti Muda
authors.forename: Fabiola
authors.initials: F
authors.lastname: Terzi
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
mesh_terms: D000328:Adult; D064591:Allografts; D017209:Apoptosis; D001706:Biopsy; D004279:DNA, Viral / Q000652:urine; D005260:Female; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications / Q000652:urine / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D017403:In Situ Hybridization; D007668:Kidney / Q000473:pathology / Q000821:virology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D007684:Kidney Tubules / Q000821:virology; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D050199:Podocytes / Q000821:virology; D016133:Polymerase Chain Reaction; D011507:Proteinuria / Q000209:etiology; D012367:RNA, Viral / Q000652:urine; D019737:Transplants / Q000473:pathology / Q000821:virology*; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral