title: HIV Infection in the Native and Allograft Kidney: Implications for Management, Diagnosis, and Transplantation.
abstract: The native kidney is a reservoir for human immunodeficiency virus (HIV)-1 and a site of viral replication, similar to lymphoid tissue, gut-associated lymphoid tissue or semen. The ability of the virus to persist may result from either a true latency or sequestration in an anatomic site that is not effectively exposed to antiretroviral therapy. The presence of HIV in kidney epithelial cells will lead progressively to end-stage renal disease. For decades, HIV-infected patients were excluded from consideration for kidney transplantation. Hemodialysis and peritoneal dialysis were the only forms of treatment available to these patients. The introduction of combined antiretroviral therapy has changed the overall prognosis of these patients and allowed them to benefit from kidney transplantation without an increased risk of opportunistic infections or cancer. However, we recently established that HIV-1 can infect kidney transplant epithelial cells in the absence of detectable viremia. The presence of HIV in kidney cells can manifest itself in multiple ways, ranging from indolent nephropathy and inflammation to proteinuria with glomerular abnormalities. Because the tools that are available to diagnose the presence of HIV in kidney cells are complex, the rate of infection is certainly underestimated. This finding will certainly have implications in the management of patients, particularly for HIV-positive donors. The purpose of this review is to highlight recent evidence that the allograft kidney can be infected by the virus after transplantation as well as the associated consequences.
authors.affiliation: 1 Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris, France. 2 Laboratoire de Virologie, Hôpital Necker Enfants Malades, Paris, France. 3 Service de Néphrologie Transplantation Adultes, Hôpital Necker-Enfants Malades, Paris, France. 4 INSERM U1151, Institut Necker Enfants Malades, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Avettand-Fenoël
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Guillaume
authors.initials: G
authors.lastname: Canaud
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D064591:Allografts; D019380:Anti-HIV Agents / Q000627:therapeutic use; D046148:Donor Selection; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000254:growth & development / Q000472:pathogenicity*; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000601:surgery* / Q000821:virology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D014779:Virus Replication
chemical_list: D019380:Anti-HIV Agents