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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The spectrum of renal histologies seen in HIV with outcomes, prognostic indicators and clinical correlations
Nephrology Dialysis Transplantation, Volume 27, No. 11, Year 2012
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Description
BackgroundTwo hundred and twenty-one HIV-positive renal biopsies were analysed from Groote Schuur Hospital to determine outcomes and prognostic indicators based on histology and clinical features.MethodsThe histology findings were compared with patient demographics, clinical and renal parameters, mortality, CD4 count and date of commencing combined anti-retroviral therapy (cART). Follow-up was between 1 and 3.5 years.ResultsWe found a spectrum of renal histologies in HIV-positive patients of which HIV-associated nephropathy (HIVAN) was the most common histology. cART reduced the mortality in those with any feature of HIVAN by 57 [adjusted hazard ratio (AHR) 0.43, 95 confidence interval (CI) 0.22-0.85]. Of those patients with HIVAN who died, 79 died of renal failure as registered on their death certificate. Proteinuria and microcysts were shown to be poor prognostic indicators (AHR 1.36: 1.09-1.70 and 2.04: 1.24-3.37). In patients with HIVAN alone followed for up to 2 years on cART, estimated glomerular filtration rate remained stable and there was a trend towards decreased proteinuria. cART improved survival in patients with isolated immune complex disease.ConclusionsAs mortality is improved in patients with any feature of HIVAN or isolated immune complex disease, cART should be initiated once any of these histological features are established. We believe the spectrum of disease that constitutes HIVAN needs to be more specifically defined. The ultimate outcome may be determined by the histological subtype. © The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Authors & Co-Authors
Wearne, Nicola
South Africa, Observatory
Groote Schuur Hospital
Swanepoel, Charles R.
South Africa, Observatory
Groote Schuur Hospital
Boulle, Andrew
South Africa, Cape Town
University of Cape Town
Duffield, Maureen Susan
South Africa, Cape Town
University of Cape Town
Rayner, Brian L.
South Africa, Observatory
Groote Schuur Hospital
Statistics
Citations: 99
Authors: 5
Affiliations: 2
Identifiers
Doi:
10.1093/ndt/gfr702
ISSN:
09310509
e-ISSN:
14602385
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study