Brief Report

Pediatric Nephrology

, Volume 26, Issue 6, pp 973-977

HIV-associated nephropathy in the setting of maximal virologic suppression

  • Shivaram HegdeAffiliated withDepartment of Paediatric Nephrology, University Hospital of Wales Email author 
  • , Cheentan SinghAffiliated withDepartment of Paediatric Nephrology, University Hospital of Wales
  • , Bernadette ÓhareAffiliated withDepartment of Paediatrics, University Hospital of Wales

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Abstract

Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is most frequently seen as a late manifestation in adult patients with a high viral load and low T-helper cell (CD4) counts. We report a case of HIVAN in a black Zimbabwean teenager in whom the disease activity was well suppressed for years following highly active antiretroviral therapy (HAART). Proteinuria was absent at 9 years of age when he presented with vertically transmitted HIV infection. Within a few months of HAART, the viral load became undetectable and CD4 count was normalised. Nephrotic range proteinuria, with preserved renal function, developed approximately 4 years later despite excellent HIV disease suppression. Renal biopsy showed non-collapsing focal segmental glomerular sclerosis changes compatible with HIVAN. Although the role of other unknown factors in the disease pathogenesis could not be totally excluded, this case demonstrates that HIVAN can still occur in HIV-infected children despite excellent HAART and that the disease manifestations and outcome may differ from those reported in previous studies.

Keywords

HIV HIV-associated nephropathy Proteinuria Nephrotic syndrome Non-collapsing focal segmental glomerulosclerosis Viral load CD4 count Proteinuria HAART