DOI 10.5414/CN107774

Clinical Nephrology, Volume 79 - April (285 - 291)

The changing pattern of glomerular disease in HIV and Hepatitis C co-infected patients in the era of HAART

Sumit Mohan1, Leal C. Herlitz2, Jennifer Tan3, Jen-Tse Cheng3, Herman L. Anderson3, Michael B. Stokes2, Glen S. Markowitz2, Vivette D. D’Agati2, Jai Radhakrishnan1
1 Department of Medicine, Division of Nephrology, 2 Department of Pathology, Columbia University College of Physicians, Surgeons, 3 Department of Medicine, Division of Nephrology, Harlem Hospital Center, New York, NY, USA

Abstract

Previous reports have suggested a poor renal prognosis in patients with HIV and HCV co-infection with a preponderance of immune complex mediated glomerular disease on biopsy. Although the benefits of HAART on HIVAN are known, its impact on co-infected patients is unclear. We describe the renal biopsy findings and renal outcome in 29 co-infected patients in the HAART era and compare them to findings in 14 historical controls reported from our institution in the pre-HAART era. Our present cohort was predominantly male and Black with the majority reporting a history of intravenous (i.v.) drug use. Renal biopsy findings included 16 patients with immune complex mediated glomerular disease and 14 patients with FSGS, of which only 3 had collapsing features and/or tubular microcysts typical of HIVAN. Five patients had other biopsy diagnoses not directly related to viral infection. Median renal survival in our cohort was 15.6 months – significantly better than the 1.7 months seen our pre-HAART cohort. The modern cohort’s improved renal outcome occurred despite older patients, longer HIV infection and similar levels of renal insufficiency. Our data indicate a changing epidemiology and natural history of renal disease in the HAART era with less immune complex mediated glomerular disease and more non-collapsing FSGS of the usual type. The marked improvement is likely to be multifactorial, including use of antiretroviral and anti-HCV therapies, RAAS antagonists, earlier nephrology referral and generally improved medical care.

Author Details

Authors

  • Sumit Mohan1
  • Leal C. Herlitz2
  • Jennifer Tan3
  • Jen-Tse Cheng3
  • Herman L. Anderson3
  • Michael B. Stokes2
  • Glen S. Markowitz2
  • Vivette D. D’Agati2
  • Jai Radhakrishnan1

Departments

  • 1 Department of Medicine, Division of Nephrology,
  • 2 Department of Pathology, Columbia University College of Physicians, Surgeons,
  • 3 Department of Medicine, Division of Nephrology, Harlem Hospital Center, New York, NY, USA

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