Hepatitis C-induced renal disease in patients with AIDS: an emergent problem

Abstract

Cryoglobulinemic membranoproliferative glomerulonephritis (MPGN) is the more characteristic renal disease associated with hepatitis C virus (HCV) infection. Patients infected with human immunodeficiency virus (HIV) can present, in addition to HIV-associated nephropathy, different types of immune complex glomerulonephritis, including MPGN, IgA nephropathy, non-collapsing focal segmental glomerulosclerosis, membranous nephropathy and lupus-like glomerulonephritis. On the other hand, the incidence of hypertensive nephrosclerosis, diabetic nephropathy and decreased renal function similar to that of elderly patients is increasingly recognized among HIV-infected patients. In spite of the fact that HCV coinfection in HIV patients is a very common problem, affecting approximately 30% of HIV-infected patients, information about the role of HCV in renal diseases of HIV-infected patients is scant. A large proportion of HIV patients with glomerular diseases are coinfected with HCV, and the latter is likely the responsible agent in those cases of cryoglobulinemic MPGN reported in HIV-infected patients. Participation of HCV in other types of HIV-related glomerular diseases is uncertain. Patient and renal survival in glomerular diseases of patients coinfected with HIV and HCV is very poor, but some studies suggest that antiretroviral therapy might change this dismal prognosis. Information about the effect of specific anti-VHC therapy or immunosuppressive agents in these patients is very limited.