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

TitleClinical characteristics and outcomes of HIV-associated immune complex kidney disease.
Publication TypeJournal Article
Year of Publication2016
AuthorsBooth J, Hamzah L, Jose S, Horsfield C, O'Donnell P, McAdoo S, Kumar E, Turner-Stokes T, Khatib N, Das P, Naftalin C, Mackie N, Kingdon E, Williams D, Hendry B, Sabin C, Jones R, Levy J, Hilton R, Connolly J and Post F
Corporate AuthorsHIV/CKD Study and the UK CHIC Study
JournalNephrol Dial Transplant
Volume31
Issue12
Pagination2099-2107
Date Published2016 Dec
ISSN1460-2385
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.

DOI10.1093/ndt/gfv436
Alternate JournalNephrol. Dial. Transplant.
PubMed ID26786550
Grant ListMR/M004236/1 / / Medical Research Council / United Kingdom
MC_UU_12023/15 / / Medical Research Council / United Kingdom
G0900274 / / Medical Research Council / United Kingdom
MR/K006584/1 / / Medical Research Council / United Kingdom
G0901997 / / Medical Research Council / United Kingdom
G0600337 / / Medical Research Council / United Kingdom