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Hiv-associated nephropathy occurring before HIV antibody seroconversion
1Divisions of Nephrology, Infectious Disease, and General Internal Medicine, Department of Medicine, and Department of Pathology, Northwestern University Medical School, Chicago, IL 60611, USA. m-levin@northwestern.edu
Summary
Human immunodeficiency virus-associated nephropathy (HIVAN) can manifest early in HIV infection, even before antibody seroconversion. This case shows HIVAN can occur during acute retroviral syndrome, challenging the notion of late-onset renal disease.
Area of Science:
- Nephrology
- Infectious Diseases
- Virology
Background:
- Human immunodeficiency virus-associated nephropathy (HIVAN) is typically observed late in HIV infection, often with high viral loads.
- It is usually associated with acquired immunodeficiency syndrome (AIDS) after prolonged viral exposure.
Observation:
- A 41-year-old man presented with nephrotic proteinuria, renal insufficiency, and acute GI/pulmonary symptoms.
- Initial HIV tests were negative, but a renal biopsy confirmed HIVAN.
- High HIV viremia (>700,000 copies/mL) was detected before seroconversion.
Findings:
- HIVAN occurred during acute retroviral syndrome, preceding positive HIV antibody tests.
- Renal biopsy confirmed HIVAN in the context of acute HIV infection.
- The patient had a high viral load and preserved CD4(+) count (>500/mm(3)).
Implications:
- HIVAN can be an early manifestation of HIV infection, not solely a late complication.
- Prolonged viral exposure is not a prerequisite for HIVAN in susceptible individuals.
- This finding necessitates considering HIVAN in patients with acute retroviral syndrome and renal abnormalities.