The Clinical and Histological Response of HIV-associated Kidney Disease to Antiretroviral Therapy in South Africans

Nephrol Dial Transplant. 2013 Jun;28(6):1543-54. doi: 10.1093/ndt/gft010. Epub 2013 Feb 26.

Abstract

Background: Little is known about the progression of kidney disease in HIV-infected patients in developing countries in the era of antiretroviral therapy (ART).

Methods: HIV-infected patients were screened for kidney disease. Kidney biopsies were performed before and after initiation of ART to assess the clinical and histological response to treatment. Data were collected from all participants in accordance with the study protocol. The mean follow-up was 2.4 patient years on ART.

Results: There was a rapid immunological and renal response to ART. The renal response was reflected by a significant rise in the estimated glomerular filtration rate (eGFR) and rapid regression of proteinuria. The histological patterns were highly variable, ranging from non-specific lesions such as mesangial hyperplasia and interstitial nephritis to HIV-immune complex disease (HIV-ICD) with or without features of HIV-associated nephropathy (HIVAN). In the follow-up biopsies, the histological response to treatment was variable with a combination of no change, progression or regression of lesions.

Conclusions: This study demonstrated a spectrum of renal histological lesions in HIV-associated kidney disease. Initiation of ART produced a rapid and sustained clinical renal response in all participants, irrespective of the histology. Follow-up biopsies showed an inconsistent histological response of lesions to treatment. In lesions that regressed, there appeared to be a discrete lag in histological response when compared with the rapid clinical response.

Keywords: HIV; HIV-associated nephropathy; antiretroviral therapy; renal histopathology.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • AIDS-Associated Nephropathy / chemically induced
  • AIDS-Associated Nephropathy / mortality*
  • AIDS-Associated Nephropathy / pathology
  • Adolescent
  • Adult
  • Aged
  • Antiretroviral Therapy, Highly Active / adverse effects*
  • Biopsy
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / virology
  • HIV-1 / pathogenicity*
  • Humans
  • Kidney Diseases / chemically induced
  • Kidney Diseases / mortality*
  • Kidney Diseases / pathology
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • South Africa
  • Survival Rate
  • Young Adult