Abstract: TH-PO1103
Beyond HIV-Associated Nephropathy (HIVAN): Kidney Biopsy Findings in the Modern Antiretroviral Therapy Era
Session Information
- Pathology and Lab Medicine
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1700 Pathology and Lab Medicine
Authors
- Finch, Alexis, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, United States
- Green, Evangeline, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Davis, Jennifer M., University of Nebraska Medical Center, Omaha, Nebraska, United States
- Ravipati, Prasanth, University of Nebraska Medical Center, Omaha, Nebraska, United States
Introduction
Human immunodeficiency virus (HIV)-associated nephropathy was historically the most common biopsy-proven kidney pathology in HIV patients. However, there has been an increasing prevalence of non-HIV-related kidney disease due to advancements in antiretroviral therapy (ART). Here, we present a case series of 3 patients with HIV (PWH) who developed a spectrum of non-HIV related kidney diseases where biopsy was crucial in guiding management strategy.
Case Description
Case 1: A 30-year-old female with controlled HIV on dolutegravir/lamivudine (DTG/3TC) developed proteinuria and hypertension while pregnant. Initially, this was attributed to pre-eclampsia, but, 6 months post-partum, she had persistent proteinuria of 2.0 g/g with normal kidney function (serum creatinine (sCr) 0.9 mg/dL). Kidney biopsy showed membranous nephropathy with masked IgG kappa deposits, prompting anti-proteinuric therapy with losartan and surveillance for possible immunomodulatory therapy. At 6 month follow up, she had stable kidney function with improved proteinuria to 1.0 g/g.
Case 2: A 42-year-old female with recent diagnosis of advanced HIV and cryptococcal meningitis (treated with liposomal amphotericin B and flucytosine) now on bictegravir/tenofovir alafenamide/emtricitabine, fluconazole, and sulfamethoxazole/trimethoprim (SMX-TMP) presented with acute kidney injury (AKI) (sCr 1.6 mg/dL from 0.8 mg/dL). Kidney biopsy showed acute interstitial nephritis with eosinophils, with SMX-TMP felt to be the most likely culprit. SMX-TMP was discontinued, oral prednisone was initiated, and sCr returned to 0.9 mg/dL.
Case 3: A 48-year-old male with HIV complicated by cryptococcal meningitis and CMV developed chronic kidney disease (sCr 1.8 mg/dL) despite adequate opportunistic infection treatment and control of HIV on DTG/3TC. Biopsy showed severe, chronic fibrosis without active inflammation, consistent with non-recovery from AKI as opposed to alternative, actionable etiology. With supportive cares, the patient has had stable kidney function, most recent sCr 1.6 mg/dL.
Discussion
Advancements in ART have changed the landscape of kidney pathologies, and one must have a broad differential for patients despite associations between HIV and specific renal pathologies. Here, each biopsy represented a key clinical finding that directly impacted management and outcome. In the modern era, early kidney biopsy should be considered in PWH with signs of nephropathy.