American Journal of Kidney Diseases
HIV-2 is distinguished from HIV-1 with low virulence, longer asymptomatic period, slower decline in CD4 count, low viral load, and low mortality from AIDS. While the kidney pathology associated with HIV-1 is well established, due to its low prevalence, kidney pathology in HIV-2 is not well documented. We report a case of HIV associated nephropathy (HIVAN) as the first presentation in a patient with HIV-2. A 65 year old man from Ghana presented within a few days of arrival to the United States with nausea, loss of appetite, shortness of breath, and bilateral lower extremity edema. He has a past medical history of hypertension and renal failure diagnosed four months prior to presentation. On admission, patient had a blood pressure of 187/100 mmHg, Hgb of 9.1 g/dl, blood urea nitrogen of 70 mg/dl, and creatinine of 10.93 mg/dl. He also had 675 mg protein in 24-hour urine collection. His echo showed left ventricular ejection fraction of 45%. Antinuclear antibody, antineutrophil cytoplasmic antibody, and anti-glomerular basement membrane antibody were negative. Complement levels (C3, C4) were normal, and serum monoclonal gammopathy evaluation was negative for monoclonal proteins. Patient was found to have a reactive HIV-2 antibody test and the HIV-2 viral load was 8 copies (<0.90 log10) per mL. Hemodialysis was initiated through a tunneled catheter. Biopsy was later done revealed 17 glomeruli of which 7 were globally sclerosed and one showed segmental sclerosis without evidence of crescent formation or necrosis, proximal and distal tubular dilation with diminished brush borders. Findings were consistent with collapsing variant of focal segmental glomerulosclerosis and interstitial fibrosis and tubular atrophy accompanied with interstitial nephritis suggestive of HIVAN. There are only three other cases reported in the literature of HIVAN as the primary presentation of HIV-2. All of which are patients of African origin. We aim to highlight the importance of testing HIV-2 and obtaining kidney biopsies in patients presenting with kidney failure from endemic regions. There is a lack of guidelines available for the initiation of antiretroviral therapy in patients with HIV-2 and renal involvement.
4 Suppl 2
Sardarli K, Daboul R, Khanal S, Zarouk S. HIV-associated nephropathy presenting as the first manifestation of HIV-2 infection. Am J Kidney Dis. 2022 Apr;79(4 Suppl 2):S59. doi:https://doi.org/10.1053/j.ajkd.2022.01.198.