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Glomerular lesions in HIV-1-infected patients: evolution from 1996 to 2007 on 88 consecutive renal biopsies. Clara Flateau, François-Xavier Lescure , Emmanuelle Plaisier, Patrice Callard, Jérôme Pacanowski, Pierre-Marie Girard, Pierre Ronco, Gilles Pialoux, for the ANAVIR study group.

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slide1

Glomerular lesions in HIV-1-infected patients: evolution from 1996 to 2007on 88 consecutive renal biopsies.

ClaraFlateau, François-Xavier Lescure, Emmanuelle Plaisier, Patrice Callard, Jérôme Pacanowski, Pierre-Marie Girard, Pierre Ronco, Gilles Pialoux,

for the ANAVIR study group.

background
Background
  • 1984 : First description of HIV-associated nephropathy (HIVAN)
  • Establishment of the direct pathogenic role of HIV-1 in HIVAN
  • Identification of genetic suceptibility locus for HIVAN in Blacks (MYH9) (Kopp et al. 2008)
  • HAART 1 :
      • Dramatic improvement of survival
      • Reduction in HIVAN incidence
      • Mild decrease in incidence of ESRD related

to HIV

  • HAART 2:
      • Nephrotoxicity of ARV agents
      • Comorbid conditions: diabetes, hypertension, aging, dyslipidemia

= Risk factors for Chronic Kidney Diseases

Lucas et al, AIDS, 2004

method
Method
  • Aims
    • Describe the typological changes of glomerular disease in HIV-infected patients over study period (1996-2007)
    • Identify discriminant variables for HIVAN
  • Design
    • Retrospective pathological study
  • Data source
    • Pathology laboratory, Tenon Hospital, APHP
    • Departments of Infectious Diseases, Tenon and Saint Antoine Hospitals, APHP
method1
Method
  • Population
    • Consecutive adult HIV-infected patients with or without antiretroviral treatment
    • Kidney biopsies from 1995 to 2007 with diagnosis of glomerular disease
  • Variables
    • Demographic variables
    • Hypertension, diabetes, dyslipidemia, history of cardiovascular events, and history of intravenous drug use.
    • Clinical data on HIV-infection, co-infections, CDC staging, history of opportunistic infections, ART history
    • Renal data including treatment, nephrotoxic drugs
    • Laboratory measurements at the time of biopsy
method2
Method
  • Kidney biopsies were analysed according to standard protocols
  • Glomerular lesions were classified according to established criteria

Glom

Tub

Classical Focal and Segmental

Glomerulosclerosis (FSGS)

HIVAN

hivan scale
HIVAN scale

ROC curve

HIVAN scale > 21 points

Sensitivity = 92%

Specificity = 81%

Positive predictive value = 67%

Negative predictive value = 96%

Area Under Curve = 0.93 (p<0.001)

Sensitivity

1-specificity

discussion
Discussion
  • Less Blacks and HCV-coinfected patients than in prior African-American studies
  • Indications for kidney biopsies could have changed between the 3 periods (under biopsy of HIVAN profile patients)
  • A real switch of FSGS types over time
  • Classical FSGS associated with long term infection, cardiovascular risk factors and lipodystrophy
  • A discriminant clinical and biological scale for identification of HIVAN
conclusion
Conclusion
  • The emergence of one glomerular disease among treated HIV-infected patients: the classical FSGS
  • A particular susceptibility for Black population concerning both main types of glomerular diseases in HIV infection, as previously shown in genetic linkage studies
  • An HIVAN scale ≤ 21 points coud lead to perform the kidney biospy