August 4, 2006 (Reuters Health) - The HIV-1 RNA level may
help distinguish HIV-associated nephropathy (HIVAN) from non-HIVAN
renal pathology, suggests a study in the August 1st issue of Clinical
Infectious Diseases.
"Although HIVAN is traditionally the most common renal lesion
affecting HIV-infected patients, non-HIVAN lesions cumulatively account
for up to one-half of renal diseases in these patients," Dr. Mohamed G.
Atta, from the nephrology division at Johns Hopkins School of Medicine
in Baltimore, and colleagues note in their report.
They retrospectively compared renal histopathological findings in 86
primarily African American HIV-positive patients according to HIV-1 RNA
levels.
"In this population, we found that HIVAN was unlikely if the HIV-1
RNA level was less than 400 copies/ml," Dr. Atta told Reuters Health.
"So, if a patient has a suppressed viral load and has clinical evidence
of kidney disease, HIVAN is unlikely in this setting," he said.
"The clinical implications, we believe, are related to locations
where kidney biopsy is not an option or contraindicated to make the
right diagnosis," Dr. Atta added.
As a whole, the study subjects displayed "an array of renal
lesions," although the majority had non-HIVAN disease. Hypertensive
vascular disease surpassed HIVAN as the single most common biopsy
finding.
"This observation may reflect an evolving profile of renal diseases
affecting HIV-infected patients as a result of systemic nonantiviral
effects of HAART or a shirt towards more-traditional causes of chronic
kidney 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 this
population by using antiretroviral therapy to suppress viral load."
