The High Burden of Asymptomatic Kidney Diseases in Individuals with HIV: A Prospective Study from a Tertiary Care Center in India

Abstract

Background HIV infection is associated with a significant kidney disease burden. This study is aimed to screen for kidney disease in all HIV patients on highly active anti retroviral therapy (HAART), study clinico-histological correlation, and assess the impact of early diagnosis on the clinical course. Materials and Methods It was a prospective, longitudinal study done in a tertiary care hospital. Adult HIV-infected patients, on HAART for at least 3 months, were screened for kidney disease. Kidney biopsy was done if indicated. Patients were treated as per standard guidelines. Results were analyzed at 3 months. Results Among 1600 patients, 966 were compliant with HAART and were tested. Two hundred and sixty-two patients completed the study duration. Out of these 262 patients 78.2% were receiving tenofovir-based ART regimen. Around 31.2% were hypertensive and 19.8% were diabetic. The mean eGFR was 57.5 ± 24 mL/min/1.73 m2. Around 19.8% had asymptomatic urine abnormalities, 40.1% had proteinuria, and 27.1% had AKI. Acute nephritic syndrome was seen in 16.4%, rapidly progressive renal failure (RPRF) in 13.3%, and CKD in 10.6% patients. Out of 74 patients who underwent biopsy, histology showed chronic tubulointerstitial nephritis in 16 (21.6%), acute tubulointerstitial nephritis in 11 (14.8%), diabetic nephropathy in 10 (13.5%), and thrombotic microangiopathy in 7 patients (9.4%). Higher viral load levels, diabetes mellitus, and age above 60 years were associated with kidney disease. Conclusion Asymptomatic HIV infection has a significant burden of kidney disease. Kidney biopsy is crucial for correct diagnosis and management. The absence of HIV associated nephropathy in proteinuric HIV patients is notable in this study.