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• W4387254009 abstract "SESSION TITLE: Critical Care Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: HIV-associated nephropathy (HIVAN) is a common cause of chronic kidney disease and end-stage renal disease in HIV-infected individuals, particularly those of African descent. While HIV viral load is known to be a significant risk factor for the development of HIVAN, the relationship between viral load and disease progression remains unclear. Studies examining the incidence and presentation of HIVAN in patients with low viral loads are limited. We describe a 51-year-old male with hypertension who presented with acute hypoxic respiratory failure, acute kidney injury and new diagnosis of HIV with low viral load subsequently diagnosed with biopsy-proven HIVAN. He was treated with highly active antiretroviral therapy resulting in improvement in renal function. This case highlights the importance of considering HIVAN in patients with low viral loads and the potential benefits of early diagnosis and management with antiretroviral therapy. CASE PRESENTATION: A 51-year-old male with hypertension was admitted to the Medical Intensive Care Unit with acute hypoxic respiratory failure and acute kidney injury treated with BiPAP. HIV screen was positive with a normal CD4 count and HIV RNA < 30 copies/mL. Urine studies revealed nephrotic-range proteinuria (4081 mg/dL). Renal biopsy confirmed focal segmental glomerulosclerosis (FSGS) due to a primary podocytopathy. He was treated with Biktarvy, a highly active antiretroviral therapy. The patient's symptoms and creatinine levels improved and he was discharged with outpatient follow-up with Nephrology and Infectious Disease. DISCUSSION: - HIVAN is a relatively common complication of HIV infection, particularly among individuals of African descent. An estimated 3.5 % of HIV-infected individuals may develop HIVAN during the course of their disease. The pathogenesis of HIVAN is thought to involve direct viral injury to podocytes resulting in glomerulosclerosis. - Diagnosis of HIVAN typically involves a combination of clinical evaluation, laboratory studies, and renal biopsy. Clinical evaluation includes assessment of kidney function and presence of proteinuria among other markers of renal disease. Laboratory studies may include measurement of HIV viral load and CD4 count, as well as other routine blood tests such as electrolyte levels and liver function tests. Renal biopsy is often required to confirm the diagnosis of HIVAN, as it can help distinguish this condition from other causes of renal disease in HIV-infected individuals. - Treatment of HIVAN involves a combination of antiretroviral therapy and supportive care. Antiretroviral therapy is aimed at reducing the viral load and preventing further direct viral injury to the kidneys. Supportive care may include treatment of hypertension, control of proteinuria, and management of other comorbidities such as hyperlipidemia and diabetes. In severe cases, renal replacement therapy such as hemodialysis or kidney transplantation may be required. - This case highlights the importance of prompt diagnosis and treatment of HIVAN. The patient's low viral load and normal CD4 count are consistent with the early HIV infection. Nonetheless, his biopsy-proven diagnosis of HIVAN demonstrates the potential renal complications which may arise with HIV infection despite low viral loads. CONCLUSIONS: Early diagnosis of HIVAN and treatment with antiretroviral therapy is critical for preserving renal function and improving long-term outcomes in patients with HIV. REFERENCE #1: Wyatt CM, Klotman PE, D'Agati VD. HIV-associated nephropathy: clinical presentation, pathology, and epidemiology in the era of antiretroviral therapy. Semin Nephrol. 2008 Nov;28(6):513-22. doi: 10.1016/j.semnephrol.2008.08.005. PMID: 19013322; PMCID: PMC2656916. REFERENCE #2: Melendez Rivera JG, Hashmi MF. HIV Nephropathy. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559134/ DISCLOSURES: No relevant relationships by Anas Al-Suraimi No relevant relationships by David Gelovani No relevant relationships by Sarah Rahman No relevant relationships by Vivek Soi" @default.
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• W4387254009 date "2023-10-01" @default.
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• W4387254009 title "HIV-ASSOCIATED NEPHROPATHY (HIVAN) IN A PATIENT WITH LOW VIRAL LOAD" @default.
• W4387254009 doi "https://doi.org/10.1016/j.chest.2023.07.1773" @default.
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