2003, Number 3
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Gac Med Mex 2003; 139 (3)
High Levels of HIV-1 RNA Associated with Early-Onset Glomerulopathy in Patients with HIV Infection.
Madrigal-Jiménez HM, Flores-Flores L, Carrillo EF, Zúñiga-Silva MA
Language: Spanish
References: 32
Page: 227-223
PDF size: 56.46 Kb.
ABSTRACT
Background: There is an association not yet known, between high levels of HIV-1 RNA and HIV- associated nephropathy (HIVAN). There is also a barely known association between HIV-1 RNA levels and HIV-associated glomerular disease.
Objective: To determine the association between high HIV-1 RNA levels and alterations in glomerular filtration rate (GFR) in patients with HIV infection.
Material and methods: We conducted a prospective trial involving 198 seropositive HIV patients. three groups were formed: 53 patients with abnormal GFR (group 1); 48 patients with proteinuria greater than 300 mg and less than 1 g in 24 h urine collection and/or with urinary cast (group 2); and 87 patients without nephropathy (group 3). We carried out comparative analysis for the most common factors associated with nephropathy in HIV seropositive patients.
Results: Within factors associated with nephropathy, only RNA-HIV-1 plasma levels had a statistically significant association with altered GFR. (p=0.008).
Conclusion: High levels of HIV-1 RNA are associated with initial forms of HIV- associated glomerulopathy, which do not have a rapid course to end- stage renal disease, but that do cause glomerular dysfunction, that could be subjected to early interventions.
REFERENCES
Kimmel PLK, Ferreira-Centeno A, Farkas-Szallasi T, Abraham AA, Garrett CT. Viral DNA in microdissected renal biopsy tissue from HIV infected patients with nephrotic syndrome. Kidney Int 1993;43:1347-1352.
Humphreys MH. Human immunodeficiency virus- associated glomerulosclerosis. Kidney Int. 1995;48:311-320.
Rao TKS, Friedman EA, Nicastri AD. The types of renal disease in the acquired immunodeficiency syndrome. N Engl J Med 1987;316:1062-1068.
Bourgoignie JJ. Renal complications of human immunodeficiency virus type 1. Kidney Int 1990;37:1571-1584.
Winston JA, Klotman PE. Are we missing an epidemic of HIV-associated nephropathy? J Am Soc Nephrol 1996;7:1-7.
D’Agati V, Appel gGB. HIV infection and the kidney. J Am Soc Nephrol 1997;8:138-152.
U.S. Renal Data System: USRDS Annual Data Report. Bethesda, National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, April 1997.
Rao TK, Filippone EJ, Nicastri AD, Landesman SH, Frank E, Chen CK, Firedman EA. Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome. N Engl J Med 1984;310:669-673.
Carbone L, D’Agati V, Cheng JT, Appel GB. Course and prognosis of human immunodeficiency virus-associated nephropathy. Am J Med 1989;87:389-395.
D’Agati V, Suh JL, Carbone L, Cheng JT, Appel GB. Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study. Kidney Int 1989;35:1358-1370.
Langs C, Gallo GR, Schacht RG, Sidhu G, Baldwin DS. Rapid renal failure in AIDS-associated focal glomerulosclerosis. Arch Intern Med 1990;150:287-292.
D’Agati V, Appel GB. Renal pathology of human immunodeficiency virus infection. Semin Nephrol 1998;18: 406-421.
Winston JA, Burns JC, Klotman PE. The human immunodeficiency virus (HIV) epidemic and HIV- associated nephropathy. Semin Nephrol 1998;18:373-377.
Klotman PE. HIV- associated nephropathy Kidney Int 1999;56:1161-1176.
Kimmel PL, Phillips TM, Ferreira- Centeno A. HIV-associated immune- mediated renal disease. Kidney Int 1993;44:1327.
Winston JA, Klotman ME, Klotman PE. HIV- associated nephropathy is a late, not early manifestation of HIV-1 infection. Kidney int. 1999;55:1036-1040.
Szczech LA, Van Der Horst C, Bartlett JA. Proteasa inhibitors are associated with a slowed progression of HIV-associated nephropathy. J Am Soc Nephrol 1999;10:116 a.
Burns GC, Paul SK, Toth IR, Sivak SL. Effect of angiotensin- converting enzyme inhibition in HIV- associated nephropathy. J Am Soc Nephrol 1997;8:1140-1146.
Schwartz EJ, Klotman PE. Pathogenesis of human immunodeficiency virus (HIV) – associated nephropathy. Semin Nephrol 1998;18:436-445.
Valeri A, Barisoni L, Appel GB. Idiopathic collapsing focal segmental glomerulosclerosis: A clinico-pathologic entity. Kidney Int 1996;50:1734.
Grcevska, L, Polenakovik, M. Collapsing glomerulopathy: Clinical characteristics and follow-up. Am J Kidney Dis 1999;33:652.
Laurinavicius A, Hurwitz S, Rennke HG. Collapsing glomerulopathy in HIV and non HIV patients: a clinicopathological and follow-up study. Kidney Int 1999;56:2203-2213.
Praditpornsilpa, K, Napathorn, S, Yenrudi, S. Renal pathology and HIV infection in Thailand. Am J Kidney Dis 1999;33:282.
Berns JC, Cohen RM, Stumacher RJ, Rudnick MR. Renal aspects of therapy for human immunodeficiency virus and associated opportunistic infections. J Am Soc Nephrol 1991;1:1061.
Cheng JT, Anderson HL, Markowitz GS. Hepatitis C virus- associated glomerular disease in patients with human immunodeficiency virus coinfection. J Am Soc Nephrol 1999;10:1566.
Weiss MA, Daquioag E, Margolin EG, Pollak VE. Nephrotic syndrome, progresive irreversible renal failure, and glomerular “collapse”. A new clinicopathologic entity? Am J Kidney Dis 1986;7:20.
Detwiler RK, Falk RJ, Hogan SL, Jennette JC. Collapsing glomerulopathy: a clinical and pathologically distinct variant of focal segmental glomerulosclerosis. Kidney Int 1994;45:1416.
Green DF, Resnick L, Gourgoignie JJ. HIV infects endothelial and mesangial but not epithelial cells. Kidney Int 1992;1:956.
Conaldi PG, Biancone L, Bottelli A. HIV-1 kills renal tubular epithelial cells in vitro by triggering an apoptotic pathway involving caspase activation and fas upregulation. J Clin Invest 1998;102:2041.
Ahsan N, Langhoff E. Immunopathogenesis of human immunodeficiency virus. Semin Nephrol 1998;18:422-435.
Yamamoto T, Noble NA, Miller DE. Increased levels of transforming growth factor- beta in hiv-associated nephropathy. Kidney Int 1999;55:579.
Wali RK, Drachenberg C, Papadimitriou JC. HIV-1-associated nephropathy and response to highly- active antiretroviral therapy. Lancet 1998;352:783.