1 / 19

Background

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.

aden
Télécharger la présentation

Background

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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.

  2. 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

  3. 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

  4. 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

  5. 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

  6. Features of patients

  7. Features of patients

  8. History of patients

  9. History of patients

  10. Histologic glomerular lesions

  11. Histologic glomerular lesions

  12. Histologic glomerular lesions

  13. Histologic glomerular lesions

  14. Patients’ characteristics according to the type of FSGS

  15. Patients’ characteristics according to the type of FSGS

  16. Risk factors associated with HIVAN

  17. 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

  18. 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

  19. 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

More Related