August 4, 2006 (Reuters Health) - The HIV-1 RNA level mayhelp distinguish HIV-associated nephropathy (HIVAN) from non-HIVANrenal pathology, suggests a study in the August 1st issue of ClinicalInfectious Diseases.

“Although HIVAN is traditionally the most common renal lesionaffecting HIV-infected patients, non-HIVAN lesions cumulatively accountfor up to one-half of renal diseases in these patients,” Dr. Mohamed G.Atta, from the nephrology division at Johns Hopkins School of Medicinein Baltimore, and colleagues note in their report.

They retrospectively compared renal histopathological findings in 86primarily African American HIV-positive patients according to HIV-1 RNAlevels.

“In this population, we found that HIVAN was unlikely if the HIV-1RNA level was less than 400 copies/ml,” Dr. Atta told Reuters Health.“So, if a patient has a suppressed viral load and has clinical evidenceof kidney disease, HIVAN is unlikely in this setting,” he said.

“The clinical implications, we believe, are related to locationswhere kidney biopsy is not an option or contraindicated to make theright diagnosis,” Dr. Atta added.

As a whole, the study subjects displayed “an array of renallesions,” although the majority had non-HIVAN disease. Hypertensivevascular disease surpassed HIVAN as the single most common biopsyfinding.

“This observation may reflect an evolving profile of renal diseasesaffecting HIV-infected patients as a result of systemic nonantiviraleffects of HAART or a shirt towards more-traditional causes of chronickidney disease,” the authors say.

“The other important message of the study is prevention of HIVAN,”Dr. Atta said. “Our results suggest that HIVAN can be prevented in thispopulation by using antiretroviral therapy to suppress viral load.”



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