Hepatitis C Virus-Associated Glomerular Disease in Patients with Human Immunodeficiency Virus Coinfection

Abstract

Abstract. Chronic infection with hepatitis C virus (HCV) has been linked to the development of glomerular disease. HCV infection is highly prevalent among intravenous drug users, a population that is also at risk for HIV coinfection. This study reports the clinical-pathologic features and outcome of HCV-associated glomerular disease (HCV-GD) in 14 patients with HIV coinfection. All were intravenous drug users and all but one were African-Americans. Renal presentations included renal insufficiency, microscopic hematuria with active urine sediment, hypertension, and nephrotic syndrome or nephrotic-range proteinuria without hypercholesterolemia. Hypocomplementemia and cryoglobulinemia were present in 46 and 33% of patients, respectively. The predominant renal biopsy findings were membranoproliferative glomerulonephritis type 1 or type 3 (Burkholder subtype) in 79% of patients and membranous glomerulopathy with atypical features in 21% (including overlap with collapsing glomerulopathy in one patient). The clinical course was characterized by rapid progression to renal failure requiring dialysis. The overall morbidity and mortality were high with median time of 5.8 mo to dialysis or death. Although most patients died in renal failure, cause of death was primarily attributable to long-term immunosuppression and advanced AIDS. Patients with AIDS had shorter survival than those without (median survival time of 6.1 mo versus 45.9 mo, log-rank test P = 0.02). Only two patients were alive with stable renal function at follow-up of 28.5 mo. In patients with HCV-GD, coinfection with HIV leads to an aggressive form of renal disease that can be easily confused with HIV-associated nephropathy. Although hypocomplementemia, cryoglobulinemia, and more prominent hypertension and microscopic hematuria may provide clues to the presence of HCV-GD, renal biopsy is essential to differentiate HCV-GD from HIV-associated nephropathy.

Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected With HIV: 2014 Update by the HIV Medicine Association of the Infectious Diseases Society of America

“…Tubulointerstitial inflammation is also common with immune complex disease, but this involves a mixture of macrophages, eosinophils, and B cells. Other diseases reported in HIV kidney biopsy series-which may or may not occur at increased frequency compared with HIV-uninfected individuals-include thrombotic thrombocytopenic purpura [93][94][95], membranous nephropathy or membranoproliferative glomerulonephritis (associated with hepatitis B or C coinfection and syphilis) [90,[95][96][97][98][99], diabetic nephropathy, hypertensive glomerulosclerosis, acute tubular necrosis, interstitial nephritis, postinfectious glomerulonephritis, chronic pyelonephritis, and amyloid [55,61,91,93,100].…”

Urinary immunoglobulins in viral diagnosis: An overview

“…Incidences of acute tubular necrosis, interstitial nephritis and glomerulonephritis have been reported in HAV patients 76 . Glomerulonephritis has also been observed in patients with HIV and HCV coinfection 77 .…”

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“…88 Other coinfected persons developed membranous nephropathy, immunotactoid glomerulopathy, mesangial proliferative glomerulonephritis, and immune-deposited collapsing glomerulopathy. 89 In summary, these coinfections lead to complicated diagnoses, clinical progression of the disease, monitoring, treatment, and the basic immunology. 78 The treatment for the coinfection of HIV−HCV usually includes dual combination therapy of interferon (IFN)−ribavirin (RBV) and highly active antiretroviral therapy (HAART).…”

“…227 2 μM, respectively (Figure 30). 232 ADMET predictor shows that 8,8′-bieckol (87), 8,4‴-dieckol (88), 6,6′-bieckol (89), and diphlorethohydroxycarmalol (90) violate three criteria of the Lipinski guidelines. These compounds also show low permeability and tend to be poor at permeating the cell membranes based on the polar surface area.…”

“…Along with liver problems, HIV–HCV coinfected people exhibit symptoms of kidney disease and have a bleaker renal prognosis. , There is an increased risk of significant kidney function deterioration in HIV–HCV coinfected women . Other coinfected persons developed membranous nephropathy, immunotactoid glomerulopathy, mesangial proliferative glomerulonephritis, and immune-deposited collapsing glomerulopathy . In summary, these coinfections lead to complicated diagnoses, clinical progression of the disease, monitoring, treatment, and the basic immunology…”