Abstract: SA-PO423

Evolution of HIV-Associated Glomerulopathy with Treatment and Time: A Study of Serial Biopsies

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 302 CKD: Estimating Equations, Incidence, Prevalence, Special Populations

Authors

  • Hung, Rachel, Royal Free Hospital, London, London, United Kingdom
  • Mahalingasivam, Viyaasan, Mid Essex Hospitals NHS Trust, Harrow, United Kingdom
  • Connolly, John, Royal Free Hospital, London, London, United Kingdom
  • Booth, John W., Royal Free Hospital, London, London, United Kingdom
Background

While the spectrum of HIV-associated glomerular disease is well described, the impact of treatment on evolution of these diseases, both clinically and histologically, is less clear. In the era of widespread antiretroviral therapy (ART) use, many patients with renal disease will be identified and investigated after a period of suppressed viral replication, potentially complicating interpretation of the renal biopsy. Serial biopsies are rarely performed so histological progression is as yet not well understood.Our aim was to examine the histologic evolution of HIV-associated glomerular disease with time and/or treatment through study of patients who had undergone serial kidney biopsies.

Methods

Patients with HIV and serial biopsies were identified through local database searches in two UK renal units. Patients whose first biopsy was considered non-diagnostic (n=2) were excluded. Histology data was obtained from structured departmental reports; all repeat biopsies had been reported with reference to the initial biopsy. Clinical data and drug treatments were obtained by review of notes and pathology databases.

Results

13 patients with glomerular disease and serial biopsies were identified (n; HIV-associated nephropathy (HIVAN)=3, immune complex kidney disease (ICKD)=6, IgA nephropathy=4). Typical collapsing glomerulopathy was not identified on the second biopsy of any patient with HIVAN, all of whom had received ART in the intervening period. 3 patients with ICKD had cellular segmental lesions with crescents in their index biopsy; all had resolved on serial biopsy leaving segmental scleroses (n=2, both received ART) or mesangial hyperplasia (n=1, received steroids). Glomerular appearances showed no improvement on serial biopsy in IgA patients; 1 patient with crescentic IgA showed no improvement on 2 serial biopsies despite robust control of viral replication

Conclusion

In this small and unique study, it was demonstrated that the morphology of established HIV-associated glomerular disease can change with treatment and time. 'Healed' segmental proliferative lesions in ICKD may simulate 'primary' FSGS, while typical collapsing glomerulopathy in HIVAN may be reversed, or obscured by glomerular obsolescence. On the other hand, viral control did not impact on histological activity of HIV-associated IgA.