(HIVAN) is a type of collapsing
FSGS . Serious renal complication of advanced
HIV infection and
AIDS leading to chronic and eventually
End Stage Renal Failure (ESRF). HIVAN is caused by direct infection of the renal cells with the HIV-1 virus and leads to renal damage through the viral gene products. It could also be caused by changes in the release of
Cytokines during HIV infection.
Usually occurs only in advanced disease and approximately 80%
of patients with HIVAN have a
CD4 count of less than 200. HIVAN presents with
Nephrotic Syndrome and progressive
Renal Failure . Despite being a cause of chronic renal failure kidney sizes are usually normal or large.
Much more common in Black and African American patients with
HIV . In the USA 12% of patients dying with
AIDS have histologically proven HIVAN, the worldwide incidence amongst
AIDS patients appears to be similar. A South African study at
Tygerberg Hospital ,
Stellenbosch University , has shown HIVAN histology in 33/61(54%)
Biopsies performed in HIV positive patients.
Among black adults in the USA it is the third most common cause of ESRF.
Involves all components of the
Nephron . Typical findings are that of collapsing
FSGS (Focal segmental glomerulosclerosis)and mycrocystic tubular dilatation.
There is as yet inadeqaute data from randomised controlled trials.
Treatment with
HAART and
ACE Inhibitors /
Angiotensin Receptor Blockers has been shown to be beneficial and should be given to all patients unless otherwise contra-indicated. General renoprotective measures and the treatment of the complications of nephrotic syndrome and renal failure are adjunctive.
Corticosteroid treatment can be useful in patients who do not respond to the above treatment. There is some evidence that
Cyclophosphamide might be helpful in selective cases, however further trials are required on both steroids and
Cyclophosphamide before these drugs can become standardised treatmen if at all.
