title: Clinical characteristics and outcomes of HIV-associated immune complex kidney disease.
abstract: The pathogenesis and natural history of HIV-associated immune complex kidney disease (HIVICK) is not well understood. Key questions remain unanswered, including the role of HIV infection and replication in disease development and the efficacy of antiretroviral therapy (ART) in the prevention and treatment of disease.
  
  
  
  In this multicentre study, we describe the renal pathology of HIVICK and compare the clinical characteristics of patients with HIVICK with those with IgA nephropathy and HIV-associated nephropathy (HIVAN). Poisson regression models were used to identify risk factors for each of these pathologies.
  
  
  
  Between 1998 and 2012, 65 patients were diagnosed with HIVICK, 27 with IgA nephropathy and 70 with HIVAN. Black ethnicity and HIV RNA were associated with HIVICK, receipt of ART with IgA nephropathy and black ethnicity and CD4 cell count with HIVAN. HIVICK was associated with lower rates of progression to end-stage kidney disease compared with HIVAN and IgA nephropathy (P < 0.0001). Patients with HIVICK who initiated ART and achieved suppression of HIV RNA experienced improvements in estimated glomerular filtration rate and proteinuria.
  
  
  
  These findings suggest a pathogenic role for HIV replication in the development of HIVICK and that ART may improve kidney function in patients who have detectable HIV RNA at the time of HIVICK diagnosis. Our data also suggest that IgA nephropathy should be viewed as a separate entity and not included in the HIVICK spectrum.
authors.affiliation: Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
authors.forename: John W
authors.initials: JW
authors.lastname: Booth
authors.affiliation: King's College Hospital NHS Foundation Trust and King's College London, London, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hamzah
authors.affiliation: Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jose
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Horsfield
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Donnell
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, Imperial College Healthcare NHS Trust and Imperial College London, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: McAdoo
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, Imperial College Healthcare NHS Trust and Imperial College London, London, UK.
authors.forename: Emil A
authors.initials: EA
authors.lastname: Kumar
authors.affiliation: Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Turner-Stokes
authors.affiliation: Heartlands Hospital NHS Foundation Trust, Birmingham, UK.
authors.forename: Nadia
authors.initials: N
authors.lastname: Khatib
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Partha
authors.initials: P
authors.lastname: Das
authors.affiliation: Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Naftalin
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, Imperial College Healthcare NHS Trust and Imperial College London, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mackie
authors.affiliation: Brighton and Sussex University Hospitals, Brighton, UK.
authors.forename: Ed
authors.initials: E
authors.lastname: Kingdon
authors.affiliation: Brighton and Sussex University Hospitals, Brighton, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Williams
authors.affiliation: King's College Hospital NHS Foundation Trust and King's College London, London, UK.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Hendry
authors.affiliation: Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, Imperial College Healthcare NHS Trust and Imperial College London, London, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Jones
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, Imperial College Healthcare NHS Trust and Imperial College London, London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Levy
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hilton
authors.affiliation: Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Connolly
authors.affiliation: King's College Hospital NHS Foundation Trust and King's College London, London, UK.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Post
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000097:blood / Q000276:immunology / Q000473:pathology* / Q000628:therapy; D000328:Adult; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000276:immunology / Q000628:therapy / Q000821:virology*; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology / Q000628:therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000097:blood / Q000276:immunology / Q000821:virology; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D012367:RNA, Viral
keywords: ART; HIV; HIVAN; HIVICK; immune complex kidney disease