HIV associated lupus like nephropathy

Human immunodeficiency virus type 1 (HIV-1)-seropositive patients are at a high risk for the development of a variety of acute and chronic renal diseases. Most patients with HIVAN are of African descent, presenting late in the course of their HIV-1 infection. The only reliable test to establish or rule out the presence of HIVAN (HIV associated nephropathy) is renal biopsy. The most common lesion associated with HIV is a focal segmental glomeruloscelerosis, but several times, other biopsy findings may also be seen. Our patient had lupus nephritis like pathology picture. The therapeutic agents with the most promise are angiotensin-converting enzyme inhibitors and antiretroviral medications. Role of steroids are less well-defined although they have been used with success many times.

Our patient was a young male who presented with a pulmonary renal syndrome like picture and wasting. On evaluation, he was found to be HIV-1 positive, and renal biopsy showed lupus nephritis like pathological picture. The patient was treated with HAART (Highly active anti retroviral therapy) , steroids and ACE inhibitors and showed an excellent response.

The case highlights the fact that immune mediated glomerulonephritis, although rare, can be the presenting feature of HIV infection and can be controlled, if not cured, with proper treatment.