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HIV-associated immune complex kidney disease

Key Points

  • HIV infection is associated with numerous adverse renal manifestations, including HIV-associated nephropathy (HIVAN), HIV-associated immune complex kidney disease (HIVICD), and other glomerulonephritides

  • Renal biopsy in patients infected with HIV is essential to differentiate HIVICD from other forms of HIV-associated kidney diseases, such as HIVAN or nephrotoxicity

  • The development of HIVICD is the result of the complex interplay between host–pathogen interactions, genetic susceptibility, and environmental factors

  • Data regarding the optimal treatment strategy for patients with HIVICD are limited

Abstract

The introduction in the late 20th century of combination antiretroviral therapy (cART) to treat patients infected with HIV has changed the natural history of the disease from an acute illness that rapidly culminates in death, to a chronic condition that can be managed with medications. Over the past decade the epidemiology of kidney disease in US patients infected with HIV has changed, perhaps because of the increased availability and use of cART. Patients with HIV infection exhibit unique immunologic characteristics, including immunodeficiency and dysregulation of immunoglobulin synthetic responses and T-cell function, which can result in glomerular immune complex deposition and subsequent kidney injury. This Review examines the differential diagnoses of HIV-associated immune complex kidney diseases (HIVICD), and discusses the clinical manifestations and mechanisms underlying their development. We address the issues associated with treatment, clinical outcomes, and research needs to enhance our ability to diagnose and optimally treat patients with HIVICD.

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Figure 1: Light microscopic features of various HIV immune complex diseases.
Figure 2: Theoretical interplay between host factors, environmental factors, genetic susceptibility, and factors associated with viral infection, in immune complex renal disease.
Figure 3: Ouchterlony diffusion plate analysis.

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All authors researched the data for the article, provided substantial contributions to discussions of its content, wrote the article, and undertook review and/or editing of the manuscript before submission.

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Correspondence to Scott D. Cohen.

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Nobakht, E., Cohen, S., Rosenberg, A. et al. HIV-associated immune complex kidney disease. Nat Rev Nephrol 12, 291–300 (2016). https://doi.org/10.1038/nrneph.2015.216

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