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Clinical characteristics and outcomes of HIV-associated immune complex kidney disease.

Booth, John W and Hamzah, Lisa and Jose, Sophie and Horsfield, Catherine and O'Donnell, Patrick and McAdoo, Stephen and Kumar, Emil A and Turner-Stokes, Tabitha and Khatib, Nadia and Das, Partha and Naftalin, Claire and Mackie, Nicola and Kingdon, Ed and Williams, Debbie and Hendry, Bruce M and Sabin, Caroline and Jones, Rachael and Levy, Jeremy and Hilton, Rachel and Connolly, John and Post, Frank A (2016) Clinical characteristics and outcomes of HIV-associated immune complex kidney disease. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 31 (12). pp. 2099-2107. ISSN 1460-2385.

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Official URL: https://academic.oup.com/ndt/article-lookup/doi/10...

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Item Type: Article
Subjects: WJ Urogenital system. Urology
Divisions: Planned IP Care > Urology
Related URLs:
Depositing User: Preeti Puligari
Date Deposited: 29 Mar 2017 15:18
Last Modified: 29 Mar 2017 15:18
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1294

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