Glomerular Pathology in Patients with HIV Infection

Abstract

The course and prognosis of patients infected with the human immunodeficiency virus (HIV) is changing dramatically following the introduction of highly active antiretroviral therapy (HAART), with increased patient survival and decreased morbidity (Mocroft et al, 1998). Current therapy offers patients increased survival by making it more susceptible to certain comorbidities (Fang et al, 2007). Cardiovascular and renal diseases are the prototype of diseases whose prevalence increases progressively with the prolonged survival and aging (Braithwaite et al, 2005). On the other hand, besides specifically associated nephropathy or HIV coinfection with hepatitis C virus (HCV) with prolonged survival of the HIV-infected population, the spectrum of kidney disease in patients with HIV also reflects the growing burden of comorbid diabetes and hypertension and development chronic renal disease (Wyatt et al, 2007; Mocroft et al 2007; Szczech, 2004). The prevalence of chronic kidney disease in HIV patients may be between 5 to 15% depending on the series. However, it has been manifested as albuminuria or proteinuria may be present up to 30% in some cohorts of HIV-infected patients (Szczech et al, 2002). The prevalence of renal histological involvement has ranged from 1-15% depending on the different autopsy series (Shahinian et al, 2000). Patients with HIV infection may develop different types of glomerular diseases, vascular lesions and tubulointerstitial nephritis related in some cases with the virus itself or other co-infections (Williams et al, 1998). In this chapter we will review at different types of glomerular diseases found in patients with HIV infection, highlighting its etipopatogenia, clinical presentation, diagnosis and therapeutic alternatives.