Malignant hypertension in HIV-associated glomerulonephritis

Area of Science:

• Nephrology
• Infectious Diseases
• Hypertension

Background:

• Glomerular diseases are common in HIV patients, but their characteristics and prognosis are poorly understood.
• Malignant hypertension (MHT) is an emerging clinical manifestation in some HIV-associated glomerulonephritis cases.

Purpose of the Study:

• To investigate the clinical characteristics and prognosis of HIV patients with glomerulonephritis.
• To determine the incidence and impact of MHT in HIV-associated glomerulonephritis.

Main Methods:

• Retrospective review of HIV-infected individuals with biopsy-proven glomerulonephritis.
• Collection of clinical, histopathologic, and outcome data.
• Comparison of MHT incidence between HIV and non-HIV glomerulonephritis patients.

Main Results:

• 33% of HIV patients with glomerulonephritis presented with MHT.
• MHT patients had higher blood pressure, more IgA nephropathy and malignant nephrosclerosis, higher viral load, and lower CD4+ counts.
• MHT was associated with significantly worse patient and renal survival, with high rates of dialysis and mortality.
• HCV and HBV co-infections were frequent in MHT patients.
• MHT incidence was higher in HIV-infected patients compared to non-HIV patients.

Conclusions:

• Malignant hypertension is a common and serious presentation of HIV-associated glomerulonephritis.
• IgA nephropathy is frequently associated with MHT in this population.
• MHT in HIV-associated glomerulonephritis portends a very poor prognosis for both patients and kidney survival.