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Glomerular disease and human immunodeficiency virus infection in Brazil
G S Lopes1, L P Marques, L S Rioja
1Department of General Medicine, School of Medicine and Surgery, University of Rio de Janeiro, Brazil.
Insights
HIV-associated nephropathy (HIV-AN) was found in 1.1% of HIV-infected patients in Brazil, with Black patients showing a higher risk. Glomerulosclerosis was a common finding, often leading to rapid kidney failure.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Human Immunodeficiency Virus (HIV) infection is associated with various renal complications.
- HIV-associated nephropathy (HIV-AN) is a significant cause of kidney disease in HIV-infected individuals.
- Understanding the prevalence and risk factors for HIV-AN in diverse populations is crucial.
Purpose of the Study:
- To determine the prevalence of clinically overt glomerular disease in HIV-infected patients in Brazil.
- To investigate the clinicopathological features and risk factors associated with HIV-AN in this population.
- To compare findings with international studies, particularly regarding racial disparities.
Main Methods:
- Retrospective analysis of 543 HIV-infected patients followed at a Brazilian National Referral Center for AIDS.
- Clinical assessment for overt glomerular disease.
- Histopathological examination of renal biopsies and autopsy samples.
- Statistical analysis to identify significant risk factors, including race.
Main Results:
- Clinically overt glomerular disease was detected in 1.1% of patients.
- Glomerulosclerosis was present in 4 cases, with 3 showing focal and segmental forms.
- Rapid progression to end-stage renal disease occurred in 4 cases within 1-10 months.
- Minimal change disease was suspected in 2 cases.
- Overt glomerular disease was significantly more prevalent in Black patients (p < 0.001).
- Focal and segmental glomerulosclerosis was found in 7.5% of patients without clinical evidence of glomerular disease.
Conclusions:
- A glomerulopathy consistent with HIV nephropathy occurs in Brazilian HIV-infected patients.
- Brazilian Black patients appear to be at an increased risk for developing HIV nephropathy.
- These findings highlight the importance of renal monitoring in HIV-infected individuals, especially those of African descent.
Abstract:
Clinically overt glomerular disease was detected in 6 (1.1%) of 543 patients with HIV infection followed at a Brazilian National Referral Center for AIDS. In 4 cases, glomerulosclerosis was present (focal and segmental in 3, diffuse and global in 1) and rapid progression to terminal renal failure was observed 1-10 months after clinical presentation. The other 2 patients died with normal renal function, and autopsy studies suggested the diagnosis of minimal change disease. Clinically overt glomerular disease was significantly more common among Black patients, whether all the cases with glomerulopathy (p < 0.001) or just the cases with glomerular sclerosis were considered (p = 0.011). Autopsy study of renal fragments from patients without clinical evidence of glomerular disease was additionally performed and revealed the presence of focal and segmental glomerulosclerosis in 3 cases (7.5%). We concluded that a glomerulopathy with clinicopathological features which match the definition of HIV nephropathy can be found among Brazilian patients with HIV infection. Accordingly to what has been described in American series, Brazilian Black patients seem to be at increased risk of the development of that nephropathy.