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Related to HIVAN: HAART, azotemia, Iban
HIVANHuman Immunodeficiency Virus-Associated Nephropathy
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Spectrum of glomerular disease in HIV Glomerular pattern Subtypes HIV-FGS or 'classic' HIVAN Some have described a mixed (HIV-associated nephropathy) variant of HIV-FGS in combination with a proliferative glomerulonephritis HIV-ICD (this group of patients Mesangial proliferative may have co-infection with hepatitis B or C) Membranoproliferative (type I and III) Lupus-like Exudative-proliferative Crescentic IgA Membranous Various glomerulonephropathies Minimal change (this is a heterogeneous group with different aetiologies) Immunotactoid Amyloidosis HIV-TTP/HUS TTP/HUS Comorbid disease Diabetic nephropathy Hypertensive nephrosclerosis Auto-immune disease (e.
8) At Baltimore's Johns Hopkins University clinic, dwindling HIVAN incidence paralleled emergence of noncollapsing focal segmental glomerulosclerosis, acute interstitial nephritis, and over a dozen other renal insults that can cause CKD, (14) defined above.
Light microscopy of HIVAN biopsies is characterized by frequently collapsing focal glomerulosclerosis.
Cases of HIVAN included HIV-infected patients with renal biopsies consistent with HIVAN and probable cases with (i) enlarged kidneys by ultrasound or radiographic imaging; (ii) nephrotic range proteinuria (>3.
Even if there were no trend toward treating everyone with HIV, these are the patients who would have firm indications to start therapy apart from HIVAN.
HIVAN is a renal syndrome in HIV-1 seropositive patients, characterized by
The substantial population prevalence of HIV infection (estimated at 6 million), even in a best-case scenario of a 1% prevalence of HIVAN in the infected population, would mean that 60 000 individuals would face this condition, which rapidly progresses to ESRF, without appropriate care.
12] HIVAN represents a huge disease burden and is ranked as the third leading cause of ESRD among blacks aged 20-64 years in the USA, lagging behind diabetes and hypertension.
11) Although cART profoundly minimized the HIVAN threat, blacks continue to run a higher risk of kidney disease than whites, partly because of single-nucleotide polymorphisms in the apolipoprotein L1 gene that arise in West Africans more than in people from other regions.
European and American-based biopsy studies reveal varying frequencies of the different histological patterns described above where HIVAN is by far the most common.
A study at Chris Hani Baragwanath Hospital in Johannesburg demonstrated HIVAN in 27% of 455 HIV patients, (4) while a study in Durban found HIVAN in 83% of cases of ESRF in antiretroviral-naive HIV-infected patients.