Original Investigation
Renal pathology and HIV infection in Thailand

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Abstract

The existence of a human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) as a distinct disease entity characterized by glomerulosclerosis is well established in North America and Western Europe. Although the large number of HIV-infected cases overwhelm the Asian countries, no cases of HIVAN are documented in the literature. We studied 26 cases of HIV-infected Thai patients with proteinuria greater than 1.5 g/d of protein during 1995 and 1996. None of the patients were treated with antiretroviral drugs at the time of renal biopsy. Intravenous drug addiction and sexual transmission were risk factors in 11 and 15 patients, respectively. Pathological examinations were performed by light microscopic and immunoperoxidase study. Mesangial proliferative glomerulonephritis was found in 17 cases, immunoglobulin A (IgA) nephropathy in 2 cases, and diffuse proliferative glomerulonephritis and interstitial nephritis secondary to cryptococcal infection in 2 cases each. One case each had membranous glomerulopathy, membranoproliferative glomerulonephritis, and granulomatous interstitial nephritis secondary to tuberculosis. The renal pathological findings of HIVAN with the unique features described in previous literature were not evident in these patients. Although the data in this study are limited to 26 HIV-infected Thai patients, we believe that HIVAN is uncommon in the Asian HIV-infected population.

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Patients

Between 1995 and 1996, HIV-infected patients receiving medical treatments in Chulalongkorn University Hospital (Bangkok, Thailand) were screened for abnormal proteinuria. Those patients with total proteinuria greater than 1.5 g/d of protein were considered for enrollment. Exclusion criteria included positive antinuclear antibody, positive hepatitis B virus surface antigen, positive anti–hepatitis C virus antibody, and fasting plasma glucose levels greater than 140 mg/dL. Patients with

Clinical features

The data listed in Table 1 come from 14 men and 12 women, ranging in age from 17 to 52 years (mean age, 31 years).

. Clinical and Laboratory Data of the 26 Patients

Patient No.Age (yr)/ SexRisk FactorStage of HIV DiseaseCD4 CountSerum Cr (mg/dL)24-Hour Urine Protein (g/d)Opportunistic InfectionPathological Diagnosis
127/MHeterosexualEarly symptomatic1320.93.1Pleural tuberculosisMesangial proliferative GN
226/WHeterosexualLate symptomatic701.21.5Cryptococcal meningitisMesangial proliferative GN
3

Discussion

The relationship between HIV infection and renal disease has been established by several investigators over the course of a decade.3, 4, 5 Glomerulopathy in HIV-infected patients has been widely reported by various centers, mostly in North America and Western Europe.6, 7 More than 350 patients with histologically proven HIVAN with unique features, more than 75 patients with diffuse mesangial proliferative glomerulonephritis, and 100 patients with other glomerulopathies have been reported in the

References (19)

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    However, in contrast to the black population from sub-Saharan Africa, Asians infected with HIV seem to be at a lower risk for developing HIV-associated nephropathy. In most series of patients with HIV infection and kidney disease from the region, kidney disease seems to have been etiologically unrelated to the HIV infection.51-53 At the same time, these patients remain at increased risk for kidney disease as a result of predilection to other infections or drug nephrotoxicity.53

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    FSGS was found only among black patients.84 There were no cases of HIVAN in a study from Thailand of 26 Asian HIV-infected patients who had a kidney biopsy.85 Twenty-three patients had ICGN, including 17 with mesangial proliferative glomerulonephritis, 2 each with IgA nephropathy or diffuse proliferative glomerulonephritis and 1 each with MPGN or membranous nephropathy.

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Received September 9, 1997; accepted in revised form August 8, 1998.

Supported by a grant from the Chongkolnee Foundation, Bangkok, Thailand.

Address reprint requests to Kearkiat Praditpornsilpa, MD, Department of Medicine, Renal Unit, Police General Hospital, Bangkok, 10500, Thailand. E-mail: [email protected]

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