Pneumocystis jirovecii Pneumonia and HIV-Associated Nephropathy in Acute HIV Infection

HIV is a retrovirus that affects the body's immune system, primarily dendritic cells, macrophages, and CD4⁺ T cells. As a result, several opportunistic infections are associated with HIV infection, including Pneumocystis jirovecii pneumonia (PJP), Toxoplasma gondii (toxoplasmosis), Cryptococcus (cryptococcosis), and Mycobacterium avium complex (MAC) infection. HIV is also associated with acute kidney injury and chronic kidney disease. The classic kidney disease related to HIV is HIV-associated nephropathy (HIVAN). HIVAN pathogenesis is linked to glomerular and renal tubular epithelial cell infection. With the advances in antiretroviral therapy, patients with HIV can live an expected lifespan without progression to AIDS and AIDS-related complications. Therefore, it is important for clinicians to recognize new-onset HIV and the complications associated with HIV. Our patient, a 32-year-old male, presented with two weeks of productive cough and one week of diarrhea. He was diagnosed with HIV and PJP based on HIV antigen/antibody testing and a sputum PJP PCR assay, respectively. The patient also had an acute kidney injury with likely underlying kidney disease suspicious of HIVAN. The patient underwent treatment for PJP and was discharged in stable condition with PJP prophylaxis.