The Evolving Spectrum of Kidney Histology in HIV-Positive Patients in South Africa

• DOI: 10.1016/j.ekir.2023.02.1076
• Publication Date: 2023-02-23T04:46:39Z
• Authors: Nicola Wearne; Kathryn Manning; Brendon Price; Brian L. Rayner; Bianca Davidson; Erika SW Jones; Ruan Spies; Carol Cunningham; Aadil Omar; Samantha Ash; Raphaela Bohmer; Luca Kennedy; Frank Post
• Keywords: Interquartile range

Sub-Saharan Africa remains challenged by the highest burden of human immunodeficiency virus (HIV), an epidemic tuberculosis (TB), and increasing number people with HIV (PWH) on antiretroviral therapy (ART), all which may result in kidney injury.This observational cohort study describes spectrum disease PWH South Africa, between 2005 2020. Kidney biopsies were analyzed 4 time periods as follows: early ART rollout (2005-2009), tenofovir disoproxil (TDF) introduction (2010-2012), TDF-based fixed dose combination (2013-2015), at diagnosis (2016-2020). Logistic regression was used to identify factors associated HIV-associated nephropathy or focal segmental glomerulosclerosis (HIVAN/FSGS) tubulointerstitial (TID).We included 671 participants (median age 36, interquartile range, 21-44 years; 49% female; median CD4 cell count 162 [interquartile 63-345] cells/mm3). Over time, (31%-65%, P < 0.001), rate suppression (20%-43%, nonelective (53%-72%, creatinine biopsy (242-449 μmol/l, 0.001) increased. A decrease HIVAN (45%-29% accompanied increase TID (13%-33%, 0.001). Granulomatous interstitial nephritis accounted for 48% TID, mostly because TB. Exposure TDF strongly (adjusted odds ratio 2.99, 95% confidence interval 1.89-4.73 0.001).As programs intensified increasingly TDF, histology evolved from a predominance era recent times. The is likely due multiple exposures that include TB, sepsis, well other insults.